Pre-Intra-Post Operative

Question 1

Pre-operative assessment

Answer 1

Is an opportunity to identify co-morbidities that may lead to patient complications during the anesthetic, surgical or postoperative period.

1. PRE OP ANAESTHETIC EVALUATION
2. PREPARATION OF THE PATIENT FOR SURGERY

Question 2

Purpose of pre-op evaluation

Answer 2

1. Identify patients, whose outcomes are likely to be improved by implementation of a specific medical treatment.
2. Identify patients, whose condition is so poor that the proposed surgery might hasten(cause) death without improving quality of life.
3. Identify those with specific characteristics that are likely to influence the anaesthetic plan.
4. Provide patients with an estimate of anaesthetic risk.
5. Opportunity to provide information to patient about the proposed anaesthesia and obtained informed consent .

Question 3

Objectives of Pre-op evaluation

Answer 3

1. To understand the impact and risk of co-existing medical disease.
2. To establish a management plan for pre-op care.
3. To obtain informed consent.
4. To establish a good CA-pt relationship.
5. To allay pt anxiety.

Question 4

Elements of pre-operative

Answer 4

1. Focused History
2. Physical examination
   •Including airway assessment
3. Necessary investigations/imaging
4. Physical status classification
5. Pre-medication

Question 5

1. History taking pre-op

Answer 5

a. Medical history (current conditions & underlying medical conditions)
→CVS: HPT, ISH, DVT, CCF, PVD, Arrhythmia e.g Untreated or poorly controlled HPT may lead to exaggerated CV response, which ↑es risk of MI & Cerebral ischemia.

→RESP: Asthma, TB, COPD, etc.

→ ESR: DM
→Hepatic: Coagulopathy

b. Current medications
c. Allergies
d. Previous Anaesthesia (drug reactions, side effects & outcomes).

e. Family history (any family member with problem during anaesthesia?)
f. Social history: smoking, alchohol
g. “NPO” status: last meal, what type of meal

Question 6

2. Physical Examination

Answer 6

a. General exam: BP, PR, RR, Temp, Sats, Urine dipstick, BMI, HGT & Hb level

b. Airway: Difficult airway is identified by:
1. Asking pt open his mouth (you must be able to insert at least 2 fingers.
2. Measuring the thyro-mental distance (min 7cm).
3. Checking for a receding mandible (lower jaw bone).
4. Checking the teeth & tongue.
5. Feeling for any soft tissue swelling & impaired mobility of the neck
6. Award a Mallamapti score to the airway

C. Cvs: Signs of PVD, Arrhythmia, CCF
D. Resp: Signs of acute infection & airway obstruction & COPD
E. Mss (eg exam of spine for spinal)
•Joint deformities (might affect movement of the neck)
•Renal /hepatic….if indicated

Question 7

Airway Assessment, Mallampati scoring

Answer 7

• Class 1: Soft palate, fauces pillars, uvula are visible.
• Class 2: Soft palate, no fauces pillars, major part pf uvular visible.
• Class 3: Base of uvula & soft palate is visible.
• Class 4: Only hard palate is visible.

Question 8

Investigations

Answer 8

1. U&E: DM, HPT, Renal failure
2. FBC: Hb< 10 active bleeding
3. LFT: Thyroid disorders, alcohol abuse
4. HGT: DM, drugs (steroids)
5. INR/PT : Coagulation disorders, liver disease, bleeding tendency
6. Eccho: ISH, Arrhythmias, VHD
7. ECG: DM, HPT, IHD nay known arrhythmia’s & age > 40yrs
8. CXR: known cardiac & resp disease, NYHA class II dyspnea prev TB, smoker, planned thoracic surgery
9. Lung function: Asthma, COPD, >NYHA Class II dyspnea

Question 9

Anesthetic Risk

Answer 9

°The anesthetist differentiates between Major & Minor risk.
° The sicker the patient, and the greater the surgical procedure, the HIGHER THE RISK

°Risk is estimated by using the American society of Anasthesiologist (ASA) classification where:

A) Class 1: A healthy person with no disease
B) Class 2: Mild, well controlled systemic disease
C) Class 3: Severe systemic disease with some limitation of activity.
D) Class 4: Severe systemic disease that is a chronic threat to life.
E) Class 5: Unlikely to survive 24 hours without surgery
F) Class 6: Brain dead/ organs are being harvested
Class E: Emergency

Question 10

Consent

Answer 10

1.Inform patient about process of anesthesia (pre-medication, theeatre environment, induction, algesia, waking up, effects & benefits of anesthesia)

2. Document finding of pre-anasthetic assessment.
3. Patient must sign Consent form

Question 11

Fasting

Answer 11

1. Reduce the risk of Gastric aspiration
2. Consider full abdomen when:
   °Head injury
   °Pregnancy
   ° Sepsis
   ° Obesity
   ° Metabolic acidosis
3. Fluids consumed within:
   °Clear fluids 2 hours
   °Breast milk 4 hours
   ° Light meal 6 hours