Anaesthetics - prep assessment and preparation

Question 1

what is identified in the pre-op Hx?

Answer 1

known comorbidities (severity and control), systemic enquiry, examination, ability to withhstand stress (exercise tolerance, cardio-resp disease), drugs and allergies, previous surgery and anaesthesia.

Question 2

what are potential anaesthesia problems which can be identified in the hx?

Answer 2

issues of the airway, spine, reflux, obesity, fhx - malignant hyperpyrexia or a cholinesterase deficiency

Question 3

what cardio-resp Ix are done?

Answer 3

cardio- ecg, ett, echo, myocardial perfusion scan, stress echo, cardiac cath, ct coronary anigogram. Resp - sats, abg, cxr, pef, fvc/fev1. gas transfer, ct chest.

Question 4

outline the ASA grading scale (NICE guidelines)…

Answer 4

ASA1	Otherwise healthy patient 
ASA2	Mild to moderate systemic disturbance
ASA3	Severe systemic disturbance 
ASA4	Life threatening disease 
ASA5 	Moribund patient 
(ASA6 Organ retrieval)

Question 5

outline some risk assessment tools…

Answer 5

GUPTA perioperative cardiac risk / Geriatric sensitive perioperative cardiac risk index / 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/ Postoperative respiratory failure calculator.

Question 6

outline the cardiac risk index…

Answer 6

high risk surgery, ihc, chf, cerebrovascular disease, DM, renal failure.

Question 7

outline the ETT MET’s (metabolic equivent of task)

Answer 7

Can you do the following activities without getting breathless; there is a 15% reduction in mortality risk per MET
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

Question 8

lifestyle risks which effect anaesthetics are…

Answer 8

smoking, obesity, alcohol (increased risk of infection and septic shock)

Question 9

what nedicatio can you not take pre-op?

Answer 9

diabetic medication and anticoagulants.