Anaesthetics- Preoperative Assessment Flashcards
What do you need to know before carrying out an operation?
- Detect unknown conditions
- Diagnose suspected conditions
- Severity of known disease
- Establishing a baseline
- Detecting complications
- Assessing risk
- Guiding management
- Documenting improvement
What do you ned to consider prior to surgery?
- Patient- Known co-morbidities, Unknown pathologies
- Nature of surgery
- Anaesthetic techniques
- Post-op care
What do you need to look for in a pre-operative history?
- Known co-morbidities- Severity, Control
- Unknown co-morbidities- Systemic enquiry, Clinical examination
- Ability of withstand stress-Exercise tolerance, Cardio-respiratory disease
- Drugs and allergies
- Previous surgery and anaesthetics
- Potential anaesthetic problems- Airway, Spine, Reflux, Obesity
- Consider rarities/ Family History: Malignant hyperpyrexia, Cholinesterase deficiency
What cardiovascular investigations should you carry out before an operation?
- ECG
- Exercise tolerance test
- Echo
- Myocardial perfusion scan
- Stress echo
- Cardiac catheterisation
- CT coronary angiogram
What respiratory investigations would you need to carry out before an operation?
- Saturations
- ABG
- CXR
- Peak flow measurements
- FVC/FEV
- Gas transfer
- CT chest
What should you check for in a cardiovascular risk assessment?
- Ischaemic heart disease
- Congestive heart failure
- Cerebrovascular disease
- Diabetes
- Renal failure
Which NICE investigations should you carry out preoperatively?
- ASA Grade
- Surgery grade
- Co-morbidities
What is the ASA grading?
- ASA1 Otherwise healthy patient
- ASA2 Mild to moderate systemic disturbance
- ASA3 Severe systemic disturbance
- ASA4 Life threatening disease
- ASA5 Moribund patient
- (ASA6 Organ retrieval)
What should you do for a high risk emergency patient?
- Informed consent
- Anaesthetic plan
- Invasive monitoring
- Senior management
- Post operative critical care
Which medication is okay to continue as normal before an operation?
Inhalers
Anti-anginals
Anti-epileptics
Which medication should you review before an operation?
Anti-diabetic medication
Anticoagulants
What does an exercise tolerance test check?
What activities the patient can do without getting breathless
How is exercise tolerance measured?
In METS
What does improved fitness lead to in terms of an operation?
Improved outcome
What is the reduction in mortality per met?
15% reduction in mortality
