Anaesthetics: Pre- op Flashcards
Where should initial pre-op assessment be carried out?
What should we find out from it?
Why is this important to know?
Primary care or pre-assessment clinic
co-morbidities, unknown pathologies, nature of surgery and post-op care
Reduces anxiety, delays, cancellations, complications, length of stay and mortality involved
What is involved within history taking pre-op
Severity of current condition, how it is controlled
Co-morbidites
Ability to withstand stress
Drugs and allergies
Potential anaesthetic problems e.g.airways, spine, obesity
FH e.g.malignant hyperpyrexia, cholinestease deficiency
What examinations are carried out?
General examination, full systems:
Cariac, Neuro, Resp, GI, MSK etc
What cardiovascular investigations could be undertaken for this procedure?
ECG Exercise tolerance tests ECHO Myocardial perfusion scans Stress ECHO Cardiac catheterisation CT coronary angiogram
What are some good risk assessment tools?
GUPTA perioperative cardiac risk Geriatric sensitive perioperative cardiac risk index surgical outcomes risk tool American college of surgeons risk tool STOP-BANG questionnaire P-possum- morbidity CR-possum- mortality V-possum- vascular complications
What are the various stages of an MET exercise tolerance test
Walk around the house without being breathless (2METS) Do light housework (3METS) walk 100-200m (4METS) climb a flight of stairs (5 METS) walk at a brisk pace (6METS) play golf, mountain walk (7METS) run a short distance (8METS) do strenous exercise (9METS)
What lifestyle changes can be made post surgery
Smoking
Alcohol- more at risk of septic shock and infection
Obesity
exercise- train fro surgery shows massive increased benefits
What medications cannot continue post op
Anti-diabetic medicines
anti-coagulants except aspirin
What is the ASA grading scale?
ASA 1- Otherwise healthy ASA 2-Mild to moderate systemic disturbance ASA 3-Severe systemic disturbance ASA 4-Life threatening disease ASA 5-Completely gone (organ retrieval)
