Anaesthetics: Pre-Op Assessment Flashcards
What surgery related trauma is there?
- Stress response
- Fluid shifts
- Blood loss
- Cardiovascular, respiratory, renal and metabolic stress
Side effects of general anaesthesia?
- Drug induced reversible coma
- CNS, cardiac and respiratory depression
- Drug interactions
Side effects of regional anaesthesia?
- Profound sympathectomy
- Neurological sequelae
What considerations are there in the pre-op assessment?
- Patient considerations including co-morbidities and unknown pathologies
- Nature of the surgery
- Anaesthetic techniques
- Post-op care
What is the role of the anaesthetist pre-op?
- Assess
- Identify high risk
- Optimise
- Minimise risk
- Inform and support patient decisions
- Consent
Why is the role of the anaesthetist pre-op essential?
Reduces
- Anxiety
- Delays
- Cancellations
- Complications
- Length of stay
- Mortality
What is involved in the pre-op assessment?
- History
- Examination
- Investigations
What history must be obtained pre-op?
- 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
What potential anaesthetic problems are there?
- Airway
- Spine
- Reflux
- Obesity
- Rarities/ family history (malignant hyperpyrexia, cholinesterase deficiency)
How is the cardiovascular system assessed pre-op?
- ECG
- Exercise tolerance test
- Echo
- Myocardial perfusion scan
- Stress Echo
- Cardiac catheterisation
- CT coronary angiogram
How is the respiratory system assessed pre-op?
- Saturations
- ABG
- CXR
- Peak flow measurements
- FVC/FEV
- Gas transfer
- CT chest
How are patients ‘graded’ for surgery?
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
Give examples of risk assessment tools.
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
What conditions are included on the cardiac risk index?
- High risk surgery
- Ischaemic heart disease
- Congestive heart failure
- Cerebrovascular disease
- Diabetes
- Renal failure
How is exercise tolerance assessed?
METS Score: Can you do the following activities without getting breathless:
- 2 METS: walk around the house
- 3 METS: do light housework
- 4 METS: walk 100-200 metres on the flat
- 5 METS: climb a flight of stairs or walk up a hill
- 6 METS: walk on the flat at a brisk pace
- 7 METS: play golf, mountain walk, dance or any form of exercise
- 8 METS: run a short distance
- 9 METS: do either strenuous exercise or heavy physical work
