Anesthetics Pre-operative assessment Flashcards
American Society of Anaesthetist (ASA) score:
(6)
American Society of Anaesthetist (ASA) score:
- Normal healthy patient
- Mild systemic disease (e.g. asthma)
- Severe systemic disease
- Severe systemic disease that is a constant threat to life
- Moribund patient, not expected to survive without the operation
- Declared brain-dead patient – organ removal for donor purposes
Surgical severity score grades:
(4)
Surgical severity score:
Grade 1 – diagnostic endoscopy, laparoscopy, breast biopsy
Grade 2 – inguinal hernia, varicose veins, adenotonsillectomy, knee arthroscopy
Grade 3 – total abdominal hysterectomy, TURP, thyroidectomy
Grade 4 – total joint replacement, artery reconstruction, colonic resection, neck dissection
Other risk assessment scoring tools:
(3)
Other risk assessment scoring tools:
NELA – National Emergency Laparotomy Audit
SORT – Surgical Outcome Risk Tool
POSSUM – Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity
Key questions to ask about previous anaesthetics include:
(4)
Has the patient had any previous anaesthetics?
- If so, was that under general anaesthetic or another method? – e.g. peripheral nerve blocks, spinal, epidural and/or sedation
Did they have any problems with previous anaesthetics?
Serious anaesthetic complications:
- Malignant hyperthermia (MH) – a rare reaction to volatile anaesthetic agents and neuromuscular blocking drugs that can cause dangerously high body temperature and muscle contractions
- Suxamethonium apnoea – a deficiency in enzymes required to break down suxamethonium, resulting in prolonged paralysis of skeletal muscle
- Anaphylaxis. See the Geeky Medics guide for clinical features of anaphylaxis.
- Difficult airway
How long did they take to wake up? Was it a few hours or a few days?
- Did they require intensive treatment unit (ITU) admission post-op due to problems waking up?
- Is there any family history of problems with anaesthetics?
- Have they or their family members had any specific testing? – i.e. genetic, allergy or other testing relating to anaesthetic agents (MH or suxamethonium apnoea)
Did they experience postoperative nausea and vomiting previously?
Serious anaesthetic complications
(4)
Serious anaesthetic complications:
- Malignant hyperthermia (MH) – a rare reaction to volatile anaesthetic agents and neuromuscular blocking drugs that can cause dangerously high body temperature and muscle contractions
- Suxamethonium apnoea – a deficiency in enzymes required to break down suxamethonium, resulting in prolonged paralysis of skeletal muscle
- Anaphylaxis. See the Geeky Medics guide for clinical features of anaphylaxis.
- Difficult airway
How long did they take to wake up?
(3)
Did they require intensive treatment unit (ITU) admission post-op due to problems waking up?
Is there any family history of problems with anaesthetics?
POST-OP NAUSEA
Key allergies to ask
(2)
List all allergies and intolerances, regardless of the severity
Ask specifically about penicillin
Ask specifically about NSAIDs
Ask about medications
(3)
Ask specifically about anticoagulants, antiplatelet agents, antihypertensives and when they last took them.
Ask about any analgesics and when they last took them.
Ask about “over the counter” and herbal medications.
CAUTIONS FOR
Maxillofacial surgery (3)
Ear, Nose and Throat surgery (2)
GI surgery (3)
Gynae surgery (2)
Maxillofacial surgery
- mouth opening
- swelling
- dental problems
Ear, Nose and Throat surgery
- snoring/sleep apnoea
- hypertension (some operations require induced hypotension to reduce bleeding and improve the surgeon’s visual field)
GI surgery
- reflux/nausea/vomiting
- features suggesting bowel obstruction
- anaemia
Gynae surgery
- nausea/reflux
- anaemia
RESPIRATORY COMPLICATIONS
(4)
Asthma/COPD:
- Regular medications, compliance and degree of control
- Recent oral steroid treatment
- Exacerbating factors
- Smoking status
Obstructive sleep apnoea:
- BMI
- Observed apnoeic episodes
- Daytime somnolence
- Do they use a CPAP mask at night?
Functional status:
- Exercise tolerance
- Able to lie flat without becoming breathless?
Other:
- Recent hospital or ITU admissions
- Recent cough/cold or features suggesting current acute illness
CARDIOVASCULAR COMPLICATIONS
(5)
Hypertension:
- How is this managed and by who?
- Do they know what is normal for them at home?
- Is there evidence of end-organ damage? – e.g. reduced renal function
Acute coronary syndrome (ACS):
- Previous myocardial infarction? When? Symptoms? What treatment?
- Have they had angiogram/PCI/CABG and what vessels were implicated?
- Recent ECHO?
Heart failure:
- Exercise tolerance
- Breathless when lying flat? (this is important as they will probably need to lie flat for their operation)
- Peripheral oedema
Valve disease:
- Syncopal episodes
- Surgical treatment
Atrial fibrillation:
- Anticoagulation
- Associated complications
MILD CARDIOVASCULAR DISEASE (3)
SEVERE CARDIOVASCULAR DISEASE (4)
MILD CARDIOVASCULAR DISEASE (3)
- Mild angina, not limiting ordinary activity
- MI > 1 month ago
- Compensated heart failure
SEVERE CARDIOVASCULAR DISEASE (4)
- Severe/unstable angina limiting activity
- MI < 1 month ago
- Decompensated heart failure
- Severe valvular disease
DIABETES HISTORY (3)
How is it controlled? Diet, oral medication or insulin?
How often do they check their capillary blood glucose and what’s normal for them?
Do they still have hypo-awareness?
RENAL HISTORY
(3)
Key questions to ask about renal disease:
- Type of renal disease and cause (if known)
- Fluid restriction
- Dialysis schedule
NEUROLOGICAL HISTORY (4)
Key questions to ask about neurological disease:
- Previous stroke or TIA?
- Residual symptoms – specifically swallowing, communication, mobility
- Epilepsy – seizure type, most recent seizure, medication
- Dementia/delirium – exacerbating factors, alleviating factors (e.g. family presence)