Lecture 1: Intro to pre-op assessment, lab testing and chart review. Flashcards
Name the eight goals of the preoperative assessment.
- Optimize care, satisfaction and comfort.
- Minimize morbidity and mortality
- Minimize surgical delays or cancellations
- Determine appropriate post-op disposition
- Evaluate health status and determine if any further consultative, diagnostic investigations are necessary.
- Formulate the most appropriate anesthetic plan.
- Optimize communication among members of the surgical and anesthetic teams.
- Evaluation should be efficient and cost-effective
What are the three main questions answered by the pre-op assessment?
- Is the patient in optimal health?
- Can, or should, the patient’s physical or mental condition be improved before surgery?
- Risk assessment: Does the patient have any health problems or use any medications that could unexpectedly influence peri-operative events.
When evaluating systemic disease what five key questions are we addressing?
- What is the severity?
- Does it have an impact on activities?
- Are there current and recent exacerbations?
- Is it controlled?
- What treatments and interventions?
What are the 9 components of the pre-op evaluation?
- Patient history
- Physical Exam
- Lab testing
- Medical consultation
- ASA physical status class
- Formulation plan
- Discussion of plan with patient
- Informed consent
- Documentation
What six things should be confirmed with the OR team regarding the schedule?
- TIme
- Anatomical location
- Position
- XRay needed
- Procedures
- OR table position.
Name eight things that should be looked at during a chart review.
- Demographic data
- Diagnosis/procedure
- Consent
- Prior H&P
- Results of lab tests
- EKG, PFT, X-Rays etc
- Vital Signs
- Medication Allergies.
What additional five pieces of information should be reviewed on inpatients?
- Progress Notes
- Medication sheets
- Nursing Notes
- Old anesthetic records
- Complications
In the optimal situation where a pre-op clinic visit 1 week prior what six things could be accomplished ahead of time?
- Patient Interview
- Physical Exam
- Anesthetic Plan
- Patient teaching and anxiety reduction
- Schedule appointments for needed consults/pre-op testing
- informed consent.
What are the 6 purposes of the pre-op interview?
- Obtain pertinent medical history
- Formulate plan of anesthetic care
- Obtain informed consent
- Patient education
- Improve efficiency, reduce cost of perioperative care
- Utilize operative experience to motivate patient to more optimal health status
What are key characteristics of a preoperative interview?
Confirm findings from chart review Use open-ended questions Go from general to specific Organized and systematic Layperson terminology Individualized Control the environment
What is the general order of the preop history taking? 11 things.
Introduce yourself Confirm the patient ID, diagnosis and procedure Review of systems Medications Previous anesthetics Exercise tolerance Sleep apnea ETOH Drug abuse Tobacco use Females-LMP
Name some types of patients that are at increased risk for aspiration.
Age extremes, under one year or over 70
ascites (ESLD)
collagen vascular disease, metabolic disorders (DM, obestity, ESRD, hypothyroid)
Hiatal hernia, GERD, esophageal surgery
Mechanical obstruction (pyloric stenosis)
Prematurity
pregnancy especially after the first trimester
neurologic diseases.
What kind of information could we possibly (if appropriate) seek from a surgeon (7)? What is always appropriate to ask?
Surgical procedure Position of the patient Special considerations Confirm abnormal lab findings (ALWAYS) Labs Blood ordered why or why not? What antibiotic do they want?
Airway is a ______ when it comes to the physical exam?
priority
What are the 4 goals of preop/preprocedure assessment and laboratory testing?
Reduce anesthetic morbidity
Increase quality of perioperative care
Decrease cose of perioperative care
Return patient to desirable functioning
What do you need to order a lab test and what must be done after ordering?
You better have a reason and you better follow up.
Explain the Litmus Test.
Ask yourself:
Will the results of this “test” change my management of this anesthetic?
Will the results of this “test” improve this patient’s outcome?
What four questions should you ask yourself about whether a lab/test is necessary?
Is it needed to confirm a suspicion?
Is the suspected abnormality linked to morbidity
IS there a higher than average likelihood of an abnormality
Will a positive or negative result affect the case management in any way?
What three resources are helpful in determining when to order a lab/test?
- Institutional Policy
- Current expert organization guidelines
- YOUR judgement.
What six considerations are part of formulating the anesthetic plan?
- type of anesthesia
- Drugs
- Monitors
- Airway
- Positioning
- Intraop monitoring
Who should the anesthetic plan be discussed with? (4)
- supervising staff
- patient
- surgeon
- OR team
What information does the patient require from from an anesthesia professional?
Discuss choices of anesthetic technique Verbal and written consent explain IVs describe the use of LA meds and fluids discuss airway management plan explain monitors transport process post operative PACU pain relief airway Possible outcomes such as sore throat, blood transfusion, facial swelling etc
What are the seven features of the final pre-op checklist?
- IV/Fluid status
- Pre-medication
- Anesthetic Plan
- Labwork- needed/results
- EKG, CXR needed? use old for comparison
- Blood products? availability and need
- Need for inhaler, steroid coverage, antibiotics?
What needs to be documented on a pre op evaluation (7)?
H&P Informed Consent NPO status Allergies ASA physical status class pre-op vital signs labs, tests and results
