Anaesthetics Pre-op assessment Flashcards
What do you want to find out about when taking a history / exam before anaesthesia?
- Known co-morbidities
- Unknown co-morbidities
- Stress tolerance
- Drugs & Allergies
- Past surgery and anaesthesia
How do we look for unknown co-morbidities?
With a full systemic enquiry and exam
What specific areas would we ask about/examine when thinking about problems with anaesthesia?
Airway Spine Reflux Obesity H/o or Fh/o malignant hyperpyrexia or cholinesterase deficiency
How do anaesthetists grade patients prior to surgery?
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
What would we do to assess a patient’s stress tolerance prior to anaesthesia?
Exercise tolerance & reasons for any limitation
Investigate any cardio-respiratory disease
How do we grade a patient’s exercise tolerance?
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
After we’ve assessed a patient’s co-morbidities, drugs/allergies and stress tolerance. What do we need to do next?
Investigate any potential illnesses/risks with tests.
Optimise medical control
Optimise lifestyle
What’s included in optimising the patient’s medical control?
optimise diabetic control
BP control
HF etc..
Some illnesses need to be well controlled to make surgery viable
Whats included in optimising the patient’s lifestyle prior to surgery?
- Smoking
- Alcohol
- Obesity
- Pre-habilitation (exercise). Its been shown that there’s a 15% reduction in mortality for every METS point you go up
What do we do about a patient’s medications when they undergo surgery?
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
Obviously with high-risk emergency patient’s we can’t go through the whole thing. What do we do?
- Informed Consent
- Anaesthetic Plan
- Invasive monitoring
- Senior management
- Post-op critical care
what are the guideline of investigations
• ASA grade • Surgery grade 1. Minor 2. Intermediate 3. Major 4. Complex • Co-morbidities
What is the point of having pre-op assessment
Reduces • Anxiety • Delays • Cancellations • Complications e.g. drinking a smoking should be stopped to prevent complications in a cardiac bypass • Length of stay • Mortality
post-op care classification
Can be classified depending on what level of attention they may require
0: Normal ward
1: normal ward with a bit more attention
2: HDU
3: Still need to be on a ventilator after op– ICU
