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Year Three - Specialities > Anaesthetics - Pre-Op Assessment > Flashcards

Anaesthetics - Pre-Op Assessment Flashcards

1
Q

What is the purpose of the pre-operative assessment?

A

It is an opportunity to identify co-morbidities that may lead to complications during the anaesthetic, surgical or post-operative period

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2
Q

When does the pre-operative assessment take place, in terms of elective procedures?

A

2 – 4 weeks before the date of their surgery

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3
Q

What does the anaesthetist ask - in term of the history of the presenting complaint? Why?

A

It includes a brief history of why the patient first attended and what procedure they have subsequently been scheduled for

There may be aspects of the disease or condition requiring surgery that are important for the anaesthetist to be aware of – for example, head and neck surgery may indicate the presence of abnormal airway anatomy

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4
Q

What aspect of the cardiovascular systemic enquiry is particularly important in the pre-operative assessment? Why?

A

Exercise tolerance

It is a useful indicator of cardiovascular fitness and can therefore be used to predict the risk of post-operative complications and level of care

In cases where poor exercise tolerance is identified, it is important to investigate if there is an underlying condition causing this

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5
Q

Why is the respiratory systemic enquiry particularly important in the pre-operative assessment?

A

During surgery, an adequate amount of oxygen and ventilation is required to reduce the risk of acute ischaemic events

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6
Q

What two respiratory clinical features exclude the administration of spinal anaesthesia?

A

Chronic cough

Orthopnoea

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7
Q

What gastrointestinal disease is important to identify in the pre-operative assessment? Why?

A

Gastro-oesophageal reflux (GORD)

This is due to the fact that the risk of aspiration is increased, and the gastric contents can be potentially fatal

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8
Q

What two other things increase the risk of aspiration during surgery?

A

Unfasted patients

Intestinal obstruction

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9
Q

What are the general fasting times for food before surgery?

A

Six hours

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10
Q

What are the general fasting times for fluid before surgery?

A

Two hours

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11
Q

How do we reduce the risk of aspiration during surgery?

A

We alter the anaesthetic technique to rapid sequence induction (RSI)

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12
Q

What is rapid sequence induction (RSI)?

A

This a method of achieving rapid control of the airway whilst minimising the risk of aspiration of gastric contents

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13
Q

What investigation is conducted in all female patients of a reproductive age as part of the pre-op assessment? When is this investigation conducted?

A

Urinary pregnancy test

Day of surgery

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14
Q

Why is past surgical history an important part of the pre-op assessment?

A

In cases where patients are having a repeat surgical procedure, the anaesthetic technique is influenced

This is due to significant changes to the surgical time and ease of the operation

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15
Q

What aspects of the patient’s anaesthetic history are included as part of the pre-operative assessment?

A

What type of anaesthesia?

What surgery was this anaesthesia administered for?

Were there any post-operative complications?

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16
Q

Why is a full drug history important in the pre-operative assessment?

A

This is due to some medications needing to be stopped or altered prior to surgery

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17
Q

What two medications require review before surgery?

A

Anti-diabetic medications

Anticoagulants

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18
Q

Why is a family history important in the pre-operative assessment?

A

This is due to the presence of hereditary conditions relating to anaesthesia

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19
Q

What are two hereditary conditions relating to anaesthesia?

A

Malignant hyperthermia

Cholinesterase deficiency

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20
Q

What two aspects of the social history are important in the pre-operative assessment?

A

Smoking use

Alcohol use

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21
Q

What two post-operative complications are associated with smoking?

A

Respiratory complications

Wound healing

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22
Q

What two post-operative complications are associated with alcohol?

A

Infection

Sepsis

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23
Q

What two examinations are included in the pre-operative assessment?

A

General examination

Airway examination

If appropriate, the area relevant to the operation can also be examined

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24
Q

What scoring system is used to assess the potential difficulty of a patient’s airway for intubation?

A

Mallampati scoring system

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25
How do we determine which pre-operative investigations to conduct?
The investigations conducted are patient-specific, depending on a number of factors – such as co-morbidities, age and the nature of the procedure. The urgency of the surgery will also dictate which conditions need further investigations and management prior to surgery. This allows time for pre-operative optimisation of surgical patients.
26
What is pre-optimisation?
It involves the detection of remediable conditions and useful interventions to ensure the patient is in optimal clinical condition prior to surgery
27
What are the six blood tests commonly conducted pre-operativley?
Full Blood Count (FBC) Urea & Electrolytes (U&Es) Liver Function Tests (LFTs) Clotting Screen Group & Save (G&S) Cross-Match
28
Why is a FBC conducted pre-operatively?
It is used to assess for any anaemia or thrombocytopenia This may require correction pre-operatively to reduce the risk of cardiovascular events or allow preparation of blood products
29
Why are U&Es conducted pre-operatively?
It is used to assess the baseline renal function, which will help inform fluid management and drug decisions for anaesthesia and post-operative analgesia
30
In which patients do we avoid the prescription of morphine in?
CKD patients
31
Why are LFTs conducted pre-operatively?
It is used to assess liver metabolism and synthesis function In cases of liver impairment, medication choice and dosing are altered
32
Why is a clotting screen conducted pre-operatively?
It is used to identify deranged coagulation, which will need to be corrected and managed appropriately in the peri-operative period
33
What is a group & save (G&S) blood test?
It determines the patient’s blood group and screens the blood for any atypical antibodies
34
When do we conduct G&S blood tests pre-operatively?
In cases where blood loss is not anticipated
35
What is a cross match blood test?
It involves physically mixing the patient’s blood with the donor’s blood This is used to monitor for the presence of an immune reaction In cases where no reactions occur, the donor blood is issued and can be transfused into the patient, otherwise alternative blood is trialled
36
Which blood test needs to be conducted before a cross-match blood test?
G&S
37
Which four cardiac investigations are commonly conducted pre-operatively?
Electrocardiogram (ECG) Echocardiogram (ECHO) Myocardial Perfusion Scan Cardiopulmonary Exercise Testing (CPET)
38
When do we conduct an ECG pre-operatively? Why?
In patients with a history of cardiovascular disease or those undergoing major surgery It can indicate any underlying cardiac pathology and provide a baseline for comparison if there are post-operative concerns for cardiac ischaemia
39
In which three circumstances do we conduct an ECHO pre-operatively? Why?
Heart murmur ECG changes Heart failure It provides the anaesthetist with information to risk stratify and tailor the intra-operative care of the patient
40
In which two circumstances do we conduct a myocardial perfusion scan pre-operatively?
Ischaemic heart disease Angina
41
What is a cardiopulmonary exercise test (CPET)?
It involves a graded intensity period on a stationary bicycle whilst the patient wears a mask, as well as ECG and blood pressure monitoring
42
What two pieces of information does a CPET provide?
VO2max Anaerobic threshold
43
When do we conduct an CPET pre-operatively? Why?
It is performed in high-risk patients undergoing major surgery In order to risk-stratify for post-operative complications and the need for higher level care environments
44
Which respiratory investigation is commonly conducted pre-operatively?
Spirometry
45
When do we conduct a spirometry pre-operatively? Why?
It is performed individuals who have a chronic lung condition It is used to assess the patient’s current baseline and predict post-operative pulmonary complications.
46
Which urinary investigation is commonly conducted pre-operatively?
Urinalysis
47
When do we conduct an urinalysis pre-operatively?
It is performed in individuals who have a suspected urinary tract infection – especially in those undergoing urological procedures
48
What additional investigation is commonly conducted pre-operatively?
An MRSA swab from the nostril and perineum
49
When do we conduct an MRSA swab pre-operatively?
In all patients
50
How do we manage a positive MRSA swab pre-operatively?
This can be treated with decontamination wash and a topical ointment prior to surgery
51
What are three pre-operative risk assessment tools?
ASA Grade Cardiac Risk Index Metabolic Equivalent of Task (METs)
52
What is an ASA grade? What information does it provide?
It is a subjective assessment of a patient’s overall health It directly correlates with their risk of post-operative complications and absolute mortality
53
Define ASA grade I
Normal healthy patient
54
Define ASA grade II
Mild systemic disease
55
Define ASA grade III
Severe systemic disease
56
Define ASA grade IV
Life threatening disease
57
Define ASA grade V
Moribund patient
58
Define ASA grade E
Organ retrieval
59
What information does the cardiac risk index provide?
The cardiac risk index is a tool used to estimate a patient’s risk of perioperative cardiac complications
60
What does the cardiac risk index involve?
It involves the assignment of a score based on the number of cardiac risk factors that the patient presents with
61
What are the six risk factors included in the cardiac risk index?
Ischaemic Heart Disease Congestive Heart Failure Cerebrovascular Disease Diabetes Chronic Kidney Disease High Risk Surgery
62
What is the metabolic rate?
It is defined as the rate of energy expended per unit of time
63
What is the metabolic equivalent of task (METs)?
It is a ratio of the patient’s working metabolic rate relative to their resting metabolic rate
64
What information does the METs provide?
It is used to estimate the patient’s cardiovascular fitness
65
What does the METs involve?
It involves the assignment of a score based on the number of activities a patient can undergo without becoming breathless
66
What MET score suggests an increased risk of peri-operative complications and morality? How do we manage these patients?
METs > 5 In these cases, pre-habilitation services are offered
67
What is more accurate in terms of determining cardiovascular fitness - CPET or METs score?
CPET

Year Three - Specialities (15 decks)

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