Anaesthetics - pre-op assessment and preparation Flashcards
What happens to the body as a result of the trauma of surgery?
Stress response
Fluid shifts
Blood loss
CVS, resp, renal, metabolic stress
What considerations must be taken into account in putting a patient into theatre?
Known co-morbidities in the patient Potential unknown pathologies Nature of the surgery Anaesthetic techniques Post-op care
What is the pre-op role of the anaesthetist?
Assessment Identify high risk Optimise Minimise risk Inform and support patient decisions Consent
What is the purpose of the pre-op assessment, etc?
Reduces anxiety Reduces delays Reduces cancellations Reduces complications Reduces length of stay Reduces mortality
How are known co-morbidities assessed in the history?
Ask about severity and how they are controlled
How are unknown co-morbidities assessed in the history?
Systemic enquiry
Clinical examination
How is the patient’s ability to withstand stress assessed?
Exercise tolerance
Reason for limitation
Cardio-respiratory disease
What is asked about in the patient’s past medical history?
Previous surgery or anaesthesia
What potential anaesthetic problems are asked about in the history?
Airway problems Spine Reflux Obesity Malignant hyperpyrexia Cholinesterase deficiency
Why are investigations done pre-op?
Detect unknown conditions Diagnose suspected conditions Severity of known disease Establish a baseline Detecting complications Assessing risk Guiding management Documenting improvement
What CVS investigations are done in patients?
ECG Exercise tolerance ECHO Myocardial perfusion scan Stress ECHO Cardiac catheterisation CT coronary angiogram
What resp investigations are done in patients?
Saturations Arterial blood gas CXR Peak flow FVC/FEV Gas transfer CT chest
What medical control should be optimised preceding surgery?
Hypertension Ischaemic heart disease Heart failure Asthma COPD Diabetes Epilepsy
What lifestyle factors should be optimised pre-op?
Smoking
Alcohol
Obesity
Exercise
What pre-op medication is stopped prior to surgery?
Anti-diabetic drugs
Anticoagulants
