Anaesthetics Pre-op assessment

Question 1

What do you want to find out about when taking a history / exam before anaesthesia?

Answer 1

• Known co-morbidities
• Unknown co-morbidities
• Stress tolerance
• Drugs & Allergies
• Past surgery and anaesthesia

Question 2

How do we look for unknown co-morbidities?

Answer 2

With a full systemic enquiry and exam

Question 3

What specific areas would we ask about/examine when thinking about problems with anaesthesia?

Answer 3

Airway
Spine
Reflux
Obesity
H/o or Fh/o malignant hyperpyrexia or cholinesterase deficiency

Question 4

How do anaesthetists grade patients prior to surgery?

Answer 4

Using the ASA grading:
1 = otherwise healthy
2 = mild-mod systemic disturbance
3 - severe systemic disturbance
4 - life threatening disease
5 - Moribund
6 - Organ retrieval

Question 5

What would we do to assess a patient’s stress tolerance prior to anaesthesia?

Answer 5

Exercise tolerance & reasons for any limitation
Investigate any cardio-respiratory disease

Question 6

How do we grade a patient’s exercise tolerance?

Answer 6

METS - Measure of Exercise Tolerance before Surgery

It’s a scale of 1-9 based on ability to do increasingly difficult activities WITHOUT getting breathless

E.g.
METS2 = walking around the house
METS5 = climb a flight of stairs or walk up hill
METS8 = Run a short distance

Question 7

After we’ve assessed a patient’s co-morbidities, drugs/allergies and stress tolerance. What do we need to do next?

Answer 7

Investigate any potential illnesses/risks with tests.

Optimise medical control and lifestyle

Question 8

What’s included in optimising the patient’s medical control?

Answer 8

optimise diabetic control
BP control
HF etc..
Some illnesses need to be well controlled to make surgery viable

Question 9

Whats included in optimising the patient’s lifestyle prior to surgery?

Answer 9

• Smoking
• Alcohol
• Obesity
• Pre-habilitation (exercise). Its been shown that there’s a 15% reduction in mortality for every METS point you go up

Question 10

What do we do about a patient’s medications when they undergo surgery?

Answer 10

Some should be kept on as normal e.g. inhalers, anti-anginals or anti-epileptics

Some should be stopped e.g. DM meds or anti-coagulants

Question 11

Obviously with high-risk emergency patient’s we can’t go through the whole thing. What do we do?

Answer 11

• Informed Consent
• Anaesthetic Plan
• Invasive monitoring
• Senior management
• Post-op critical care