Anaesthetics: Preoperative assessment Flashcards
Why are we so concerned about a pre-operative assessment?
The trauma of surgery ○ Stress response ○ Fluid shifts ○ Blood loss ○ Cardiovascular, respiratory, renal and metabolic stress
What types of anaesthesia do you get?
○ General anaesthesia - Drug induced reversible coma - CNS, cardiac and respiratory depression - Drug interactions ○ Regional anaesthesia - Profound sympathectomy - Neurological sequelae
What should you consider before a surgery?
○ Patient - Known co-morbidities - unknown pathologies ○ Nature of surgery ○ Anaesthetic techniques ○ Post-op care
What is the anaesthetists pre-op role?
○ Assess ○ Identify high risk ○ Optimise ○ Minimise risk ○ Inform and support patients decisions ○ Consent
Why do anaesthnatists have a pre-op role?
- Reduces □ Anxiety □ Delays □ Cancellations □ Complications □ Length of stay □ Mortality
When should anaesthnatists have a pre-op role?
- Elective planned surgery □ Primary care □ Pre-assessment clinic - Urgent surgery - Emergency surgery
What history should be taken as part of the pre-op assessment?
- Known co-morbidities □ Severity □ Control - Unknown co-morbidities □ Systemic enquiry □ Clinical examination - Ability of withstand stress □ Exercise tolerance □ Reason for limitation □ Cardio-respiratory disease - Drugs and allergies - Previous surgery and anaesthesia - Potential anaesthetic problems □ Airway □ Spine □ Reflux □ Obesity - Rarities / Family history □ Malignant hyperpyrexia □ Cholinesterase deficiency
What investigations should you do as part of the pre-op assessment?
□ Cardiovascular ® ECG ® Exercise tolerance test ® Echo ® Myocardial perfusion scan ® Stress echo ® Cardiac catheterisation ® CT coronary angiogram
□ Respiratory ® Saturations ® ABG ® CXR ® Peak flow measurements ® FVC/FEV ® Gas transfer ® CT chest
Why should you do investigations as part of the pre-op assessment?
□ Cardiovascular ® ECG ® Exercise tolerance test ® Echo ® Myocardial perfusion scan ® Stress echo ® Cardiac catheterisation ® CT coronary angiogram
□ Respiratory ® Saturations ® ABG ® CXR ® Peak flow measurements ® FVC/FEV ® Gas transfer ® CT chest
What are the different ASA grades?
- 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 is the cardiac risk index?
- High risk surgery
- Ischaemic heart disease
- Congestive heart failure
- Cerebrovascular disease
- Diabetes
- Renal failure
What happens in the exercise tollerance tests? (and how is the scoring done)
- Can you do the following activities without getting breathless;
□ Walk around the house 2 METS
□ Do light housework 3 METS
□ Walk 100-200 metres on the flat 4 METS
□ Climb a flight of stairs or walk up a hill 5 METS
□ Walk on the flat at a brisk pace 6 METS
□ Play golf, mountain walk dance, or any form of exercise 7 METS
□ Run a short distance 8 METS
□ Do either strenuous exercise or heavy physical work 9 METS
What conditions should you optimise medical control?
- Hypertension
- Ischaemic heart disease
- Heart failure
- Asthma
- COPD
- Diabetes
- Epilepsy
What is pre-habilitation?
○ Improved fitness = improved outcomes
○ 15% reduction in mortality risk per MET
○ Prescribing exercise
What should you do with high risk emergency patients?
○ Informed consent ○ Anaesthetic plan ○ Invasive monitoring ○ Senior management ○ Post-operative critical care
