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Gwen - Anaesthetics > Pre-Assessment > Flashcards

Pre-Assessment Flashcards

1
Q

What’s the point in a pre-op assessment?

A
  • An opporunity toidentify co-morbidities that may lead to patient complcations during the anaethetic, surgical or post op period.
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2
Q

When do people get there pr-op assessment?

A

2-4 weeks

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3
Q

What is ECOG stage 0?

A

Fully active, able to carry on all pre-disease performance without restriction

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4
Q

What is ECOG grade 1?

A

Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work

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5
Q

What is ECOG grade 2?

A

Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours

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6
Q

What is ECOG grade 3?

A

Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours

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7
Q

What is ECOG grade 4?

A

Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair

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8
Q

What is ECOG grade 5?

A

Death

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9
Q

What is ASA score of 1?

A

Normal, healthy individual

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10
Q

What is an ASA score of 2?

A

Mild systemic disease - Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease

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11
Q

What is an ASA score of 3?

A

Severe systemic disease - Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents.

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12
Q

What is ASA score of 4?

A

A patient with severe systemic disease that is a constant threat to life - Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

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13
Q

What is an ASA score of 5?

A

A moribund patient who is not expected to survive without the operation - Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

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14
Q

What is an ASA score of 6?

A

A declared brain-dead patient whose organs are being removed for donor purposes

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15
Q

What cardiovascular problems may you want to ask about in the pre-operative assessment?

A
  • IHD
  • HF
  • HTN
  • Valvular disease
  • Conduciton defects
  • Arrythmias
  • PVD/DVT
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16
Q

What are the main surgical grades used to determine the appropriate tests to do pre-operatively?

A
  • Minor
  • Intermediate
  • Major
  • Major plus surgery
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17
Q

What respiratory conditions would you want to screen for in pre-operative assessment?

A
  • COPD
  • Asthma
  • Infection
  • Restrictive lung disease
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18
Q

What criteria need to be met for patients to deemed low risk for surgery?

A
  1. No coexisting medical problems
  2. Have coeisting medical problem that is well controlled and does not impair daily activity
  3. Do not require/require only baseline investigations
  4. Have no Hx of anaesthetic difficulties
  5. Require surgery with minimal complicaiton risk
19
Q

How would you assess exercise tolerance in pre-op assessment?

A
  • Could you run for a bus?
  • How far uphill can you walk?
  • How far can you walk on flat?
  • Are you able to do shopping?
  • How many stairs?
  • Able to do housework/take care of yourself?
20
Q

What other considerations (besides CVS, Resp and exercise tolerance) might you want to investigate/ask about in the pre-op assessment?

A
  • Indegestion/Reflux
  • RA
  • DM
  • Neuromuscular disorders
  • Chronic renal failure
  • Jaundice - liver dysfunciton
21
Q

When would you consider doing U+E’s in a patient as part of pre-op assessment?

A
  • Taking drugs - digoxin, diuretics, steroids
  • Diabetes
  • Renal disease
  • Vomiting
  • Diarrhoea
22
Q

When would you consider doing LFT’s in someone for pre-op assessment?

A
  • Hepatic disease
  • High alcohol intake
  • Metastatic disease
  • Evidence of malnutrition
23
Q

When would you consider doing blood sugars in someone as part of pre-op assessment?

A
  • Diabetes
  • Severe PVD
  • Long term steroids
24
Q

When would you consider doing an ECG in someone as part of their pre-op assessment?

A
  • Hypertensive
  • IHD
  • Cardiac arrythmia
  • Diabetes > 40 years old
25
Q

When would you consider a CXR as part of your pre-op assessment?

A
  • Cardiac/respiratory disease
  • Known/suspected malignancy
  • Thoracic surgery planned
  • Suspected TB
26
Q

When would you consider doing pulmonary function tests in somoene as part of a pre-operative assessment?

A
  • Symptoms of dyspnoa on mild exertion
  • COPD
  • Asthma
27
Q

If a patient was found an pulmonary function tests to be dyspnoeic or cyanosed at rest, or FEV1 < 60%, what additional investigation would you consider?

A

Arterial blood gas while breathing AIR

28
Q

When might you consider a coagulation screen in someone for pre-op assessment?

A
  • Anticoagulant therapy
  • History of bleeding diathesis
  • History of liver disease/jaundice
29
Q

When might you consider doing a C-spine x-ray in someone as part of their pre-op assessment?

A
  • RA
  • Major trauma/surgery to the neck
  • Difficult intubation is predicted
30
Q

What systems would you want to assess pre-operatively in a diabetic patient?

A
  • CVS - HTN, IHD, CVD, MI
  • Renal - Kidney disease
  • Resp - prone to infections
  • Airway - thicking of soft tissues
  • GI - delayed gastric empting = prone to reflux
31
Q

What pre-operative investigations would you consider doing in a diabetic patient?

A
  • Examination - any signs of complications
  • HbA1c - 20-48 mmol/mol
  • U+E’s
  • Blood sugar
  • ECG
  • CXR
32
Q

How would you manage a diabetic patient in the pre-operative setting?

A
  • Individualize diabetes management
  • Place patient first on list
  • Avoid overnight admission if possible
  • If Planned short starvation/miss meal - variable-rate IV insulin infusion
    • Try to avoid short starvation
33
Q

What investigaitons should you consider as part of your pre-operative assessment of someone with asthma?

A
  • How well it is managed
  • Document allergies/triggers
  • Therapy being used
  • PEFR
  • Spirometry
  • ABG -severe asthma
  • ECG
  • CXR
34
Q

What investigations might you consider doing in somoene with COPD as part of your pre-op assessment?

A
  • Spirometry
  • ABG - moderate to severe COPD
  • ECG
  • CXR
35
Q

How would you optimise COPD patient before surgery?

A
  • Stop smoking - at least 8 weeks before is optimal
  • Adjust LAMA/SAMA/LABA/SABA therapy
  • Preoperative chest physio
  • Pulmonary rehab
36
Q

How would you evaluate a hypertensive patient pre-operatively?

A
  • Assess whether primary of secondary
  • Assess severity
  • Asses end-organ involvement
37
Q

How would you manage hypertension pre-operatively?

A
  • Optimise hypertensive treatment
  • Consider deferal of surgery if severe
38
Q

How would you evaluate somoene with heart failure in pre-op assessment?

A
  • History and examination
  • Optimise treatment - symptomatic arrythmias, diuretics etc.
  • Consider appropriate investigaitons
39
Q

What investigations would you consider doing in someone with HF as part of you pre-op assessment?

A
  • Bloods - FBC, U+E’s, LFTs, TFTs, Fasting lipids, glucose
  • ECG
  • CXR
  • TTE - grade impairment
  • Consider Cardiac catheterisaiton
40
Q

What investigations would you consider doing in someone with IHD as part of your pre-operative assessment?

A
  • Grading as per METS criteria
  • ECG
  • ETT
  • MRI perfusion scan
41
Q

How would you assess/grade exercise tolerance?

A
42
Q

What is used to meausure to measure risk of major perioperative cardiav event? List the components

A

Cardiac risk index

  • High risk surgery
  • History IHD
  • History CCF
  • Histor cerebrovascular disease
  • DM
  • Serum creatinine >180 mEq/l
43
Q

Whats the 2-4-6 rule?

A
  • 2 hours clear fluids/tea/coffee
  • 4 hours breast milk
  • 6 hours food

Gwen - Anaesthetics (16 decks)

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