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Anaesthesiology > Pre-op > Flashcards

Pre-op Flashcards

1
Q

Describe the ASA classification to stratify the pre operative physical status (7 )

A

I: healthy patient
II: mild systemic disease eg obesity, treated ht, controlled dm 2, smoker (no functional limitation )
III: severe systemic disease, not incapacitating eg mild cardiac failure, distant prev mi (some), diabetes, poorly controlled HT
IV: severe systemic disease, constant threat to life eg exsanguinated with ruptured ectopic pregnancy, severe renal failure, recent MI, EF <25% (functionally incapacitated)
V: moribund, not expected to survive 24h irrespective of operation eg ruptured aneurysm
VI: brain dead presenting for organ donation
E: Emergency

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2
Q

Describe and interpret the METS (metabolic equivalents) scores (4)

A

1: can read, watch TV, eat, get dressed, walk 100m on level ground- poor candidate for anaesthesia
2-3: can walk on level ground 3-4 km/h , light housework
4-10: can climb few stairs, walk on level ground 6 km/h, run short distances, heavy household chores, moderately strenuous sports eg golf, dancing. - Can handle anaesthesia
>10: highly strenuous sports eg soccer - excellent candidates

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3
Q

Name 4 risk factors post op pulmonary complications

A

•age > 60
• severe COPD
• reduced exercise tolerance
• Heart failure
• surgery > 3h

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4
Q

What must hba1c be before elective surgery?

A

<9

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5
Q

Describe the NPO guidelines pre-op

A

2,4,6,8 rule

8 hours before surgery: no meat or fried, fatty food.

6 hours: no milk or solid food

4 hours: no breast mik

2 hours(new guide line 1h for Paeds ): NPO, no clear fluids

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6
Q

Which medications should be discontinued pre-op in hypertensive patients?

A

• ace-i and arb morning of surgery (10 hours pre-op) to prevent acute hypotension
• continue beta blocker and diuretics

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7
Q

Which medications should be discontinued pre-op in diabetic patients?

A

Stop oral hypoglycaemic (metformin because risk intra-op lactic acidosis, sulfonylureas because risk hypoglycaemia) 1-2 days before surgery and convert to insulin sliding scale if necessary

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8
Q

Which premedication can be given to anxious adults?

A

Midazolam

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9
Q

Which pre-op special investigations should be performed in asymptomatic patients in which major blood loss is expected? (5)

A

• FBC
• clotting
• UCE
• ECG
• Blood typing

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10
Q

Which pre-op special investigations should be performed in asymptomatic neonates? (2)

A

• FBC
• UCE

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11
Q

Which pre-op special investigations should be performed in asymptomatic males aged 40-49? (1)

A

ECG

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12
Q

Which pre-op special investigations should be performed in asymptomatic patients aged 50-64? (1)

A

ECG

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13
Q

Which pre-op special investigations should be performed in asymptomatic patients aged 65 or more? (5)

A

•Fbc
• UCE
• blood glucose
• ECG
.Cxr

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14
Q

Which pre-op special investigations should be performed in asymptomatic cardiovascular disease? (4)

A

• FBC
• UCE
• ECG
• CXR

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15
Q

Which pre-op special investigations should be performed in asymptomatic lung disease? (3)

A

FBC
CXR
ECG

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16
Q

Which pre-op special investigations should be performed in asymptomatic bronchial hyperreactivity? (1)

A

Lung functions - must be able to hold breath at least 15 seconds (sabrazes test - measure FRC)

17
Q

Which pre-op special investigations should be performed in asymptomatic smoking 20 pack years or more? (2)

A

ECG
CXR

18
Q

Which pre-op special investigations should be performed in lung resection? (6)

A

FBC
UCE
BGA
ECG
CXR
lung function test

19
Q

Which pre-op special investigations should be performed in asymptomatic kidney disease or diuretic use? (4)

A

FBC
UCE
ECG
CXR

20
Q

Which pre-op special investigations should be performed in asymptomatic hepatobiliary disease? (5)

A

FBC
UCE
clotting (APTT, PT, INR)
blood glucose
LFT

21
Q

Which pre-op special investigations should be performed in asymptomatic DM? (5)

A

FBC
UCE
blood glucose
ECG (silent MI)
CXR

22
Q

Which pre-op special investigations should be performed in asymptomatic CNS disease? (2)

A

FBC
UCE

23
Q

Which pre-op special investigations should be performed in malignancy/oncotherapy? (5)

A

FBC
UCE
LFT
ECG
CXR

24
Q

Which pre-op special investigations should be performed in asymptomatic abnormal clotting? (2)

A

FBC
clotting (APTT, PT, INR)

25
Q

Which pre-op special investigations should be performed in CV medication use? (2)

A

ECG
UCE

26
Q

Which pre-op special investigations should be performed in corticosteroid use? (2)

A

UCE
blood glucose

27
Q

Which pre-op special investigations should be performed in anticoagulant use? (2)

A

FBC
clotting (APTT, PT, INR)

28
Q

Which pre-op special investigations should be performed in planned induced hypotension? (3)

A

FBC
UCE
LFT

29
Q

Which pre-op special investigations should be performed in patients that need post op intensive care? (1)

A

BGA

30
Q

Name 3 Resp conditions that justify cancellation elective surgery

A

Bronchospasm
Upper airway infection within last 2 weeks
Productive cough or pneumonia previous 6 weeks

31
Q

Minimum haematocrit in anaemia and polycythaemia to proceed with elective surgery?

A

> 25%

32
Q

Minimum haematocrit in healthy patients to proceed with elective surgery?

A

> 21%

33
Q

Minimum haematocrit in paediatric patients to proceed with elective surgery?

A

Younger than 3 months: >30% (high O2 consumption)
Older babies: >27%

34
Q

Minimum haematocrit in patients with hypoxic hypoxia to proceed with elective surgery?

A

30%

35
Q

4 steps of the pre-op evaluation?

A
  1. Optimise: chronic disease/rx stop/add, clinical findings eg wheeze, special investigs eg Hb
  2. Risk stratify: (ASA I-IV), MET’S
  3. Anaesthetic plan: premed, GA, regional, airway, monitoring, post op care
  4. Informed consent
36
Q

Name 5 contraindications pre-op sedatives

A
  • if it will aggravate hypoxia eg lung disease, cyanosis heart disease
  • any airway pathology: decreased muscle tone can cause obstruction
  • increased sensitivity to sedatives: sleep apnea
  • decreased level of conciousness
  • babies younger than 1 or below 10kg (unless constant observation)
37
Q

Name 3 classes of sedatives with examples that can be used pre-op

A
  • benzodiazepines: midazolam, temazepam, oxazepam
  • opioids: morphine, tilidine. Especially good for pre-op pain
  • antihistamines: promethazine, trimeprazine (antisialogogue and antiemetic, but no longer widely used due to extrapyramidal effects, prolonged sedation, hypotension)
38
Q

What is kefzol?

A

Cephazolin: first generation cephalosporin

39
Q

What does kefzol cover?

A

Broad spectrum, mainly skin flora
Gram positive staph and strep
Some gram negative: e coli, moraxhella catarrhalis, klebsiella pneumonia, proteus mirabilis

Anaesthesiology (24 decks)

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