Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

Chronic cough

Orthopnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

Unfasted patients

Intestinal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the general fasting times for food before surgery?

A

Six hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the general fasting times for fluid before surgery?

A

Two hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do we reduce the risk of aspiration during surgery?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What two medications require review before surgery?

A

Anti-diabetic medications

Anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are two hereditary conditions relating to anaesthesia?

A

Malignant hyperthermia

Cholinesterase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

Smoking use

Alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What two post-operative complications are associated with smoking?

A

Respiratory complications

Wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What two post-operative complications are associated with alcohol?

A

Infection

Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

Mallampati scoring system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do we determine which pre-operative investigations to conduct?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is pre-optimisation?

A

It involves the detection of remediable conditions and useful interventions to ensure the patient is in optimal clinical condition prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the six blood tests commonly conducted pre-operativley?

A

Full Blood Count (FBC)

Urea & Electrolytes (U&Es)

Liver Function Tests (LFTs)

Clotting Screen

Group & Save (G&S)

Cross-Match

28
Q

Why is a FBC conducted pre-operatively?

A

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
Q

Why are U&Es conducted pre-operatively?

A

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
Q

In which patients do we avoid the prescription of morphine in?

A

CKD patients

31
Q

Why are LFTs conducted pre-operatively?

A

It is used to assess liver metabolism and synthesis function

In cases of liver impairment, medication choice and dosing are altered

32
Q

Why is a clotting screen conducted pre-operatively?

A

It is used to identify deranged coagulation, which will need to be corrected and managed appropriately in the peri-operative period

33
Q

What is a group & save (G&S) blood test?

A

It determines the patient’s blood group and screens the blood for any atypical antibodies

34
Q

When do we conduct G&S blood tests pre-operatively?

A

In cases where blood loss is not anticipated

35
Q

What is a cross match blood test?

A

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
Q

Which blood test needs to be conducted before a cross-match blood test?

A

G&S

37
Q

Which four cardiac investigations are commonly conducted pre-operatively?

A

Electrocardiogram (ECG)

Echocardiogram (ECHO)

Myocardial Perfusion Scan

Cardiopulmonary Exercise Testing (CPET)

38
Q

When do we conduct an ECG pre-operatively? Why?

A

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
Q

In which three circumstances do we conduct an ECHO pre-operatively? Why?

A

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
Q

In which two circumstances do we conduct a myocardial perfusion scan pre-operatively?

A

Ischaemic heart disease

Angina

41
Q

What is a cardiopulmonary exercise test (CPET)?

A

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
Q

What two pieces of information does a CPET provide?

A

VO2max

Anaerobic threshold

43
Q

When do we conduct an CPET pre-operatively? Why?

A

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
Q

Which respiratory investigation is commonly conducted pre-operatively?

A

Spirometry

45
Q

When do we conduct a spirometry pre-operatively? Why?

A

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
Q

Which urinary investigation is commonly conducted pre-operatively?

A

Urinalysis

47
Q

When do we conduct an urinalysis pre-operatively?

A

It is performed in individuals who have a suspected urinary tract infection – especially in those undergoing urological procedures

48
Q

What additional investigation is commonly conducted pre-operatively?

A

An MRSA swab from the nostril and perineum

49
Q

When do we conduct an MRSA swab pre-operatively?

A

In all patients

50
Q

How do we manage a positive MRSA swab pre-operatively?

A

This can be treated with decontamination wash and a topical ointment prior to surgery

51
Q

What are three pre-operative risk assessment tools?

A

ASA Grade

Cardiac Risk Index

Metabolic Equivalent of Task (METs)

52
Q

What is an ASA grade? What information does it provide?

A

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
Q

Define ASA grade I

A

Normal healthy patient

54
Q

Define ASA grade II

A

Mild systemic disease

55
Q

Define ASA grade III

A

Severe systemic disease

56
Q

Define ASA grade IV

A

Life threatening disease

57
Q

Define ASA grade V

A

Moribund patient

58
Q

Define ASA grade E

A

Organ retrieval

59
Q

What information does the cardiac risk index provide?

A

The cardiac risk index is a tool used to estimate a patient’s risk of perioperative cardiac complications

60
Q

What does the cardiac risk index involve?

A

It involves the assignment of a score based on the number of cardiac risk factors that the patient presents with

61
Q

What are the six risk factors included in the cardiac risk index?

A

Ischaemic Heart Disease

Congestive Heart Failure

Cerebrovascular Disease

Diabetes

Chronic Kidney Disease

High Risk Surgery

62
Q

What is the metabolic rate?

A

It is defined as the rate of energy expended per unit of time

63
Q

What is the metabolic equivalent of task (METs)?

A

It is a ratio of the patient’s working metabolic rate relative to their resting metabolic rate

64
Q

What information does the METs provide?

A

It is used to estimate the patient’s cardiovascular fitness

65
Q

What does the METs involve?

A

It involves the assignment of a score based on the number of activities a patient can undergo without becoming breathless

66
Q

What MET score suggests an increased risk of peri-operative complications and morality? How do we manage these patients?

A

METs > 5

In these cases, pre-habilitation services are offered

67
Q

What is more accurate in terms of determining cardiovascular fitness - CPET or METs score?

A

CPET

Year Three - Specialities (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions