Anaesthetics: Pre-Op Assessment Flashcards
What surgery related trauma is there?
- stress response
- fluid shifts
- blood loss
- cardiovascular, respiratory, renal and metabolic stress
What is general anaesthesia?
- drug induced reversible coma
- CNS, cardiac and respiratory depression
- drug interactions
What is regional anaesthesia?
- profound sympathectomy
- neurological sequelae
What considerations are there in the pre-op assessment?
- patient: co-morbidities, unknown pathologies
- nature of the surgery
- anaesthetic techniques
- post-op care
What is the role of the anaesthetist pre-op?
- assess
- identify high risk
- optimise
- minimise risk
- inform and support patient decisions
- consent
Why is the role of the anaesthetist pre-op essential?
reduces
- anxiety
- delays
- cancellations
- complications
- length of stay
- mortality
What is involved in the pre-op assessment?
- history
- examination
- investigations
What history must be obtained pre-op?
- co-morbidities
- ability to withstand stress (exercise tolerance, reason for limitation, cardio-respiratory disease)
- drugs and allergies
- previous surgery and anaesthesia problems
What potential anaesthetic problems are there?
- airway
- spine
- reflux
- obesity
- rarities/ family history (malignant hyperpyrexia, cholinesterase deficiency)
What is the purpose of pre-op investigations?
- detect unknown/suspected conditions
- severity of condition
- establish a baseline
- detect complications
- assess risk
How is the cardiovascular system assessed pre-op?
- ECG
- exercise tolerance test
- echo
- myocardial perfusion scan
- stress Echo
- cardiac catheterisation
- CT coronary angiogram
How is the respiratory system assessed pre-op?
- saturations
- ABG
- CXR
- peak flow measurements
- FVC/FEV
- gas transfer
- CT chest
How are patients ‘graded’ for surgery?
ASA grade
- ASA 1: Otherwise healthy patient
- ASA2: Mild to moderate systemic disturbance
- ASA3: Severe systemic disturbance
- ASA4: Life threatening disease
- ASA5: Moribund patient
- ASA6: Organ retrieval
What conditions are included on the cardiac risk index?
- high risk surgery
- ischaemic heart disease
- congestive heart failure
- cerebrovascular disease
- diabetes
- renal failure
How is exercise tolerance assessed?
METS Score: Can you do the following activities without getting breathless:
- 2 METS: walk around the house
- 3 METS: do light housework
- 4 METS: walk 100-200 metres on the flat
- 5 METS: climb a flight of stairs or walk up a hill
- 6 METS: walk on the flat at a brisk pace
- 7 METS: play golf, mountain walk, dance or any form of exercise
- 8 METS: run a short distance
- 9 METS: do either strenuous exercise or heavy physical work
