Anaesthetics: Pre-Operative Assessment

Question 1

Presenting complaint?

Answer 1

What is the procedure/when to be carried out/why carried out

Question 2

Previous surgery & anaesthesia?

Answer 2

PONV?
Awareness/dreams?
Difficult incubation?
Delayed recovery?
Suxamethonium apnoea?
Malignant hyperthermia?

Question 3

Past Medical History?

Answer 3

CVS: hypertension, palpitations, angina, MI, heart failure, orthopnoea, stroke or TIA, valvular

Resp: asthma, COPD, dyspnoea, apnoea (sleep), cough, current infection, e.g. TB

GI/renal: GORD (heartburn), vomiting, dysphagia, liver disease, renal failure

CNS/MSK - arthritis (rheumatoid), ankyolising spondylitis, neuromuscular problems, epilepsy

Other: diabetes, sickle cell anaemia, pregnancy

Question 4

Drug History?

Answer 4

Prescribed medication (insulin, anticoagulants, any changes in medication)
OTC and alternative medical remedies
ALLERGIES

Question 5

Social History?

Answer 5

Recreational drug use (esp. ecstasy, cocaine, narcotics)
Smoking (stopping prior to surgery improves outcomes – even if 24hrs)
Alcohol (risk of alcohol withdrawal, liver failure)

Question 6

Family History?

Answer 6

o Malignant hyperthermia
o Prolonged apnoea – usually due to suxemethonium
o Sickle-cell disease

Question 7

Dental history?

Answer 7

o Loose teeth
o Crowns
o Dentures

Question 8

Exercise tolerance?

Answer 8

o How many flights of stairs can you walk up without stopping?
o How far can you walk on the flat without stopping?
o Can you do your own shopping/housework?
o Weight

Question 9

Fasting times:

Answer 9

Need to have had no solid food or milk for 6 hours (preferably from night before, and do not eat foods high in fat or fibre day before) , chewing gum and sweets are classed as solid food.
No clear fluids from 2 hours before an operation, unless up to 30ml permitted in order to take medication up to ½ an hour before the operation.

Question 10

Examination?

Answer 10

CVS
RS
Nervous system 
MSK
BMI (height & weight)

Question 11

ASA grade?

Answer 11

1 - Fit and well
2 - Systemic illness, normal function (e.g. mobility)
3 - Systemic illness, affects function
4 - Illness constant threat to life
5 - Unlikely to survive with or without operation

Question 12

Assessment/Investigations?

Answer 12

FBC, U&E’s, group save & cross match
LFTs (including clotting screen), blood glucose, ECG, CXR,

Ask, assess:

Open and close mouth fully –> jaw mobility
Mallampati score
Asses neck mobility –> flex & extend neck
Asses dentition state: loose teeth, crowns, filling, dentures
Bring lower jaw in front of top

Question 13

What is the mallampati score?

Answer 13

Class I: Complete visualisation of the soft palate
Class II: Complete visualisation of the uvula
Class III: Visualisation of only the base of the uvula
Class IV: Soft palate not visible at all

Question 14

Risks for anaesthetics?

Answer 14

1/20 have blurred vision
1/100 risk of CVA event
1/100 risk of dural puncture headache following spinal

Question 15

Explanation?

Answer 15

Fasting prior to operation, stop solids 6 hours before
Can drink only water, but clear fluids stopped 2hours before also (gum too!!!)
Pre meds can be given to take away anxiety e.g. BZD’s
Post op pain relief will be available in many different forms.
Post op nausea possible, reassure: is normal, anti sickness tabs available
Can‟t drive home, needs some help whilst at home.

Question 16

What drug do you give for malignant hyperthermia?

Answer 16

Dantrolene