Anaesthetics: Pre-Op Assessment Flashcards
1
Q
What surgery related trauma is there?
A
- Stress response
- Fluid shifts
- Blood loss
- Cardiovascular, respiratory, renal and metabolic stress
2
Q
What is general anaesthesia?
A
- Drug induced reversible coma
- CNS, cardiac and respiratory depression
- Drug interactions
3
Q
What is regional anaesthesia?
A
- Profound sympathectomy
- Neurological sequelae
4
Q
What considerations are there in the pre-op assessment?
A
- Patient considerations including co-morbidities and unknown pathologies
- Nature of the surgery
- Anaesthetic techniques
- Post-op care
5
Q
What is the role of the anaesthetist pre-op?
A
- Assess
- Identify high risk
- Optimise
- Minimise risk
- Inform and support patient decisions
- Consent
6
Q
Why is the role of the anaesthetist pre-op essential?
A
Reduces
- Anxiety
- Delays
- Cancellations
- Complications
- Length of stay
- Mortality
7
Q
What is involved in the pre-op assessment?
A
- History
- Examination
- Investigations
8
Q
What history must be obtained pre-op?
A
- Known co-morbidities
- Unknown co-morbidities via systemic enquiry
- Ability to withstand stress (exercise tolerance, reason for limitation, cardio-respiratory disease)
- Drugs and allergies
- Previous surgery and anaesthesia
- Potential anaesthetic problems
9
Q
What potential anaesthetic problems are there?
A
- Airway
- Spine
- Reflux
- Obesity
- Rarities/ family history (malignant hyperpyrexia, cholinesterase deficiency)
10
Q
What is the purpose of pre-op investigations?
A
- Detect unknown conditions
- Diagnose suspected conditions
- Severity of known disease
- Establishing a baseline
- Detecting complications
- Assessing risk
- Guiding management
- Documenting improvement
11
Q
How is the cardiovascular system assessed pre-op?
A
- ECG
- Exercise tolerance test
- Echo
- Myocardial perfusion scan
- Stress Echo
- Cardiac catheterisation
- CT coronary angiogram
12
Q
How is the respiratory system assessed pre-op?
A
- Saturations
- ABG
- CXR
- Peak flow measurements
- FVC/FEV
- Gas transfer
- CT chest
13
Q
How are patients ‘graded’ for surgery?
A
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
14
Q
Give examples of risk assessment tools.
A
- GUPTA perioperative cardiac risk
- Geriatric sensitive perioperative cardiac risk index
- Surgical outcome risk tool
- American college of surgeons surgical risk calculator
- STOP-BANG questionnaire
- Nottingham hip fracture score
- P-POSSUM
- CR-POSSUM
- Q-POSSUM
- V-POSSUM
- Postoperative respiratory failure calculator
15
Q
What conditions are included on the cardiac risk index?
A
- High risk surgery
- Ischaemic heart disease
- Congestive heart failure
- Cerebrovascular disease
- Diabetes
- Renal failure
