Operative assessment

Question 1

Why is a history of a) cardiovascular b) respiratory disease required?

Answer 1

a) increased risk of acute cardiac event during anaesthesia

b) affects the oxygenation of the patient

Question 2

What aspects of past anaesthetic history should be enquired?

Answer 2

Has the patient had general anaesthesia before; have they suffered any previous post-op nausea and vomiting

Question 3

What is the ASA grade?

Answer 3

Correlates with risk of post-op complications and mortality; goes from I (normal, healthy) to V (moribund)

Question 4

Standard blood tests prior to surgery? (5)

Answer 4

FBC
U and E's to assess renal function
LFTs
Clotting
G&S/X-match

Question 5

What aspects of the airway are examined? (4)

Answer 5

Degree of mouth openining (inter-incisor distance)
Teeth- loose?
Oropharynx- Mallampati score
Neck

Question 6

How is Mallampati score calculated?

Answer 6

I- soft palate, uvula and tonsillar pillars visualized
II- soft palate, uvula seen; tonsillar pillars not visible
III- only base of uvula seen
IV- uvula not visualized

Question 7

What does Mallampati score predict?

Answer 7

Degree of difficulty of intubation

Question 8

Examination of neck in pre-op assessment?

Answer 8

ROM- flexion, extension, lateral flexion
Thyromental distance (with neck in maximal extension)

Question 9

What does a thyromental distance of less than 6.5cm suggest?

Answer 9

Difficult intubation