Lecture Notes in Anaesthesia - Chapter 1 Flashcards
ASA1 Pre-op investigations by age
Parts of pre-operative anaesthetic history? (7)
Parts of pre-operative anaesthetic history (7)
Indication for surgery
PMH
Exercise tolerance
Previous anaesthetics/operations
Family Hx
Drug Hx/allergies
Social Hx
Features of pre-assessment anaesthetic history taking - CV
Ask specifically about which cardiovascular conditions(6)
Heart failure assessed using which scale?
- ischaemic heart disease;
- heart failure;
- hypertension;
- valvular heart disease;
- conduction defects, arrhythmias;
- peripheral vascular disease, previous deep
- venous thrombosis (DVT) or pulmonary embolus
- (PE).
HF is assessed with New York Heart Association classification (NYHA).
Features of pre-assessment anaesthetic history - Resp
Enquire specifically about (4)
Additional risk factors (3)
- COPD
- Asthma
- Infection
- Restrictive lung disease
Additional risk factors - obesity, upper abdominal or thoracic surgery, acute URTI
Assessment of exercise tolerance
Questions (5)?
Objective scale?
- How far can you walk on the flat?
- How far can you walk uphill?
- How many stairs before stopping?
- Able to do housework/shopping?
- Able to do self-cares?
Specific Activity Scale
Assessing the patient’s anatomy with respect to airway (7)
- limitation of mouth opening;
- a receding mandible;
- position, number and health of teeth;
- size of the tongue;
- soft tissue swelling at the front of the neck;
- deviation of the larynx or trachea;
- limitations in flexion and extension of the cervical
- spine.
Bedside tests to screen for difficult airway (4)
- Mallampati criteria (III & IV suggest difficult airway)
- Thyromental distance (>7cm)
- Calder test (protrude mandible as far as possible - lower incisors aligned with or posterior to upper incisors = difficult)
- Wilson score (increasing weight, reduced head and neck movement, reduced mouth opening, receding mandible, buck-teeth)
Common risks of anaesthesia (7)
Definition of common?
Common (1 in 10 to 1 in 100)
These are not life threatening and can occur even when anaesthesia has apparently been uneventful. They include:
- bruising and soreness from attempts at IV access;
- sore throat;
- headache;
- dizziness;
- postoperative nausea and vomiting;
- itching;
- retention of urine.
Uncommon risks of anaesthesia (5)
Definition of uncommon?
Uncommon (1 in 1000)
- dental damage;
- chest infection;
- muscle pains;
- an existing condition worsening, such as myocardial infarction;
- awareness during general anaesthesia.
Rare risks of anaesthesia (5)
Definition of rare?
Rare (<1 in 10000)
- allergy to the anaesthetic drugs;
- eye injury, particularly if prone;
- nerve damage;
- hypoxic brain injury;
- death.
Define ASA 1
A healthy patient with no organic or psychological disease process. The pathological process for which the operation is being performed is localized and causes no systemic upset.
Absolute mortality 0-0.3%
Define ASA 2
Absolute mortality?
A patient with a mild to moderate systemic disease process, caused by the condition to be treated surgically or another pathological process, that does not limit the patient’s activities in any way e.g. treated hypertensive, stable diabetic. Patients aged >80 years are automatically placed in class II
Absolute mortality 0.3-1.4%
Define ASA 3
Absolute mortality %?
A patient with severe systemic disease from any cause that imposes a definite functional limitation on activity e.g. ischaemic heart disease, COPD.
1.5-5.4%
Define ASA 4
Absolute mortality %?
A patient with a severe systemic disease that is a constant threat to life, e.g. unstable angina.
Absolute mortality 7.8-25.9%
Define ASA 5
Absolute mortality %?
A moribund patient unlikely to survive 24 hours with or without surgery
Absolute mortality 9.4-57.8%
