Pre-assessment Clinic

Question 1

Anaesthetic pre-assessment clinic is key to providing patients with a smooth and safe … operation.

Answer 1

Anaesthetic pre-assessment clinic is key to providing patients with a smooth and safe elective operation.

Question 2

Elective surgery refers to ….

Answer 2

Elective surgery refers to operations that are planned in advance to admission to hospital at a time convenient for the patient, staff and hospital. Patients undergoing elective surgery should always be pre-assessed prior to admission to hospital.

Question 3

… testing should be carried out on all patients who are … on the day of surgery with consent of the patient

Answer 3

Pregnancy testing should be carried out on all patients with child-bearing potential on the day of surgery with consent of the patient. Each locality will have its own guidelines on pregnancy testing prior to the day of surgery.

Question 4

Patients with a history of diabetes should have a recorded … within the last three months before surgery.

Answer 4

Patients with a history of diabetes should have a recorded HbA1c within the last three months before surgery.

Question 5

Patients with a history of diabetes should have a recorded HbA1c within the last … months before surgery.

Answer 5

Patients with a history of diabetes should have a recorded HbA1c within the last three months before surgery.

Question 6

… should be considered in those with heart murmur associated with cardiac symptoms or features of heart failure before surgery

Answer 6

Echocardiogram should be considered in those with heart murmur associated with cardiac symptoms or features of heart failure.

Question 7

NICE advise considering the following investigations for minor surgery in patients with an ASA III/IV: (2)

Answer 7

ECG: If no result available in the past 12 months.

Renal function: If patient is at risk of AKI.

Question 8

For intermediate surgery for patients with ASA I blood tests and ECGs are not routinely advised. In those with an ASA II, NICE advise: (2)

Answer 8

ECG: Consider if history of cardiovascular disease, renal impairment or diabetes.
Renal function: If patient is at risk of AKI.

Question 9

For intermediate surgery in those with an ASA III/IV the following is advised: (5)

Answer 9

FBC: If history of cardiac or renal disease if no recent investigations for symptoms
Clotting screen: Consider if history of chronic liver disease (prudent to also check if history of other coagulopathies)
ECG: Routinely arrange
Renal function: Routinely arrange
Lung function: Consider if history of respiratory disease

Question 10

For major complex surgery what investigations should be carried out for ASA I or II?

Answer 10

FBC should be checked in all patients. In those with an ASA I, renal function testing should be considered if at risk of AKI. In those with an ASA I over the age of 65 an ECG may be arranged if one is not available in the last 12 months.

In those with an ASA II NICE advise:

FBC: Routinely arrange
ECG: Routinely arrange
Renal function: Routinely arrange

Question 11

For major complex surgery what investigations should be carried out for ASA III or IV?

Answer 11

FBC: Routinely arrange
Clotting screen: Consider if history of chronic liver disease (prudent to also check if history of other coagulopathies)
ECG: Routinely arrange
Renal function: Routinely arrange
Lung function: Consider if history of respiratory disease

These patients are also more likely to have been seen in more extensive pre-assessment clinics or high-risk anaesthetic clinics.

Question 12

Routine fasting advice pre-op - what is standard advice?

Answer 12

No food for 6 hours prior to surgery
Clear fluids until 2 hours prior to surgery
Nil by mouth from that point on

Question 13

A number of ‘… … pathways’ now feature carbohydrate drinks, taken up to two hours prior to surgery to improve peri-operative nutrition and recovery.

Answer 13

A number of ‘enhanced recovery pathways’ now feature carbohydrate drinks, taken up to two hours prior to surgery to improve peri-operative nutrition and recovery.

Question 14

NICE advise considering stopping oestrogen containing hormone replacement therapy (HRT) how long prior to elective surgery to reduce the risk of venous thromboembolism?

Answer 14

NICE advise considering stopping oestrogen containing hormone replacement therapy (HRT) 4 weeks prior to elective surgery to reduce the risk of venous thromboembolism.

Question 15

In certain settings the COCs need to be stopped pre-operatively to reduce the risk of venous thromboembolism. NICE CKS advise COC should be stopped 4 weeks prior to what types of surgery? (3)

Answer 15

Major surgery (including any operation lasting longer than 30 minutes)
Any operation on the legs
Any procedure involving prolonged immobilisation of legs

Alternative contraceptive methods should be offered to the patient if cessation of the COC is required.