ASA grading and pre-op investigations

Question 1

ASA grade 1

Answer 1

Question 2

ASA grade 2

Answer 2

Question 3

ASA grade 3

Answer 3

Question 4

ASA grade 4

Answer 4

Question 5

ASA grade 5

Answer 5

Question 6

ASA grade 6

Answer 6

Question 7

ASA grade E

Answer 7

Question 8

What scale is used to classify the complexity of surgery?

Answer 8

The four-point scale (NICE)

Question 9

What is the test sensitivity?

Answer 9

The sensitivity of the test is the proportion of diseased patients who have a positive test result

Question 10

What is the test’s specificity?

Answer 10

The specificity of the test is the proportion of healthy patients who have a normal test result

Question 11

What is Positive Predictive Value (PPV)?

Answer 11

The positive predictive value (PPV) is the likelihood of a patient with a positive result having disease

Question 12

What is the Negative Predictive Value (NPV)?

Answer 12

The negative predictive value (NPV) is the likelihood of a patient with a normal result not having disease

Question 13

What factors do recommendations for preoperative tests depend on?

Answer 13

• age
• surgical severity
• whether the patient has systemic disease

Question 14

What are the criteria for ordering peri-operative tests?

Answer 14

Question 15

Who do we offer Sickle-cell test to? (peri-operatively)

Answer 15

Sickle cell tests should be offered to anyone with:

• a family history of homzygous disease or heterozygous trait
• African or Afro-Caribbean ancestry; Asian ancestry; Middle-Eastern ancestry; East-Mediterranean ancestry (including Cyprus).

Question 16

Who do we offer pregnancy test to (preoperatively)?

Answer 16

Any woman who says she may be pregnant

Question 17

What are examples of indications to order FBC (pre-operatively)?

Answer 17

suspected anaemia

Question 18

What are examples of indications to order CXR (pre-operatively)?

Answer 18

Recent respiratory illness which is still symptomatic

Question 19

What are examples of indications to order FBC and coagulation screen (pre-operatively)?

Answer 19

History of prolonged bleeding

Question 20

What are examples of indications to order ECG (pre-operatively)?

Answer 20

History of palpitations

Question 21

What are examples of indications to order respiratory function tests and ABGs (pre-operatively)?

Answer 21

severe respiratory disease

Question 22

What are examples of indications to order ECHO (pre-operatively)?

Answer 22

in undiagnosed murmur

Question 23

Why do we do cardiopulmonary exercise testing (CPX)?

What does it measure?

Answer 23

Major surgery puts the major stress on a body

• It is a non-invasive procedure that involves progressively raising the level of exercise whilst monitoring the body’s metabolic state
• to assess the extent to which oxygen delivery can be increased to meet the tissue needs
• An important measure is the anaerobic threshold - the point at which oxygen delivery is no longer adequate and anaerobic metabolism starts.