Pre-Anesthesia Assessment (including CV) Flashcards
Identify the Major goals of the pre-anesthesia evaluation
- optimize pt care and satisfaction
- reduce periop morbidity/mortaity
- minimize surgical delays/cancelations
- determine ideal postop pt disposition (home, Inpatient, ICU)
- evaluate pt health status and preop testing needs
- formulate a plan (can obtain consent)
- ensure time efficient, cost effective pt evaluation
what are pros of a dedicated pre-op clinic (PAT)
- overall saves money
- one stop shop
- pt registered, teaching, consults, diagnostic testing
- reduced anxiety
- reduced cancellations
- reduce length of hospitalizations (shift to out pt sx)
- reduce wasteful diagnostic testing
-
what are cons of a dedicated pre-op clinic (PAT)
- another appointment to make
- time consuming
- transportation problems
- not very private area
why look at the medical record if you can interview the pt
- the record provides the basis for direction of the pt interview and physical assessment
- it does this by providing an insight into the pt’s past and present med hx
outline the elements of a pre-anesthesia interview
- current problems
- current meds
- allergies
- ETOH/tobacco/ illicit drug use
- anesthesia problems (past)
- Family Hx (and r/t anesthesia)
- A ROS with emphisis on
- –CV, lungs, renal, GI, endocrine, hematological, general activity level, psych, dermatological, pregnancy, airway issues
outline the elements of the pre-anesthesia Physical exam
Vital signs Airway Heart Lungs Extremities Neuro
ASA I give description and examples
- a normal healthy pt
- pt for a
- bunion repair
- hernia repair
- lumpectomy
- asymptomatic fibroids
ASA II give description and examples
- a pt with a MILD systemic disease that results in NO FUNCTIONAL LIMITATIONS
- well controlled HTN
- well controlled Asthma
- Well controlled DM
- Mild obesity
- cigarette use (unless dr. mcd ask)
ASA III give description and examples
-a pt with a SEVERE systemic disease that results in FUNCTIONAL LIMITATIONS
-Poorly controlled HTN
-Poorly controlled asthma
-poorly controlled DM
-COPD
-AF with control
-CVA
O2 SATURATION 90-93%
ASA IV give description and examples
- a pt with SEVERE systemic disease that is a CONSTANT THREAT TO LIFE
- unstable angina
- CHF
- debilitating resp disease
- O2 SATURATION ,90% AT REST
- hepatorenal failure
ASA V give description and examples
- a MORIBUND pt who is not expected to survive without the operation
- uncontrolled hemorrhage from ruptured AAA
ASA VI give description and examples
-a pt decleared brain dead for organ donation
ASA E give description and examples
- any pt whome an emergency operation is required
- acute trauma
- emergent c-section
- ruptured appy
Evaluation of the CV system includes the determination of what 4 things
1) pre-existing CV disease (HTN, Ischemic valve disease, valular dysfunction, etc)
2) disease severity, stability, and prior treatments
3) comorbidities (DM, PVD, COPD)
4) the type of sx being performed
a standard means of categorizing the degree of CV disability is the what
New York Heart Association classification
how many classes are in the NYHA class
4
NYHA class I
- pt’s with cardiac disease
- NO FUNCTIONAL LIMITATIONS to physical limitations
NYHA class II
- pts with cardiac disease who are comfortable at rest
- SLIGHT functional limitations to physical activity
- ORDINARY activity results in fatigue
NYHA class III
- pts with cardiac disease resulting in MARKED LIMITATIONS to physical activity
- LESS than ordinary activity results in fatigue
NYHA class IV
- pts with the INABILITY TO CARRY ON ANY PHYSICAL activity
- symptoms of CV insufficiency are PRESENT AT REST
guidlines for ordering pre-anesthesia lab test
- cost effective
- positive benefit risk ratio
- ready for evaluation prior to sx
- test should yeild information that can’t be obtained from h&p
- abnormal results in asymptomatic pts would influance pt and anesthesia care
men > 40-50 yo should have what prior to sx
ECG
