Pre Op

Question 1

Recent chest infection

Answer 1

Should be assessed for anaesthetic risk and SSI risk

Question 2

Four metabolic equivalents

Answer 2

= climbing flight of stairs

-inability of four –> increases cardiac risk during major surgery

Question 3

Indications for baseline bloods

Answer 3

Major operation

Elderly >65 years

Relavent systemic disease
e.g. steroids, diuretics, digoxin, non-steroidal anti inflammatory drugs, intravenous fluid or nutrition therapy and endocrine problems

Question 4

Indications for ECG

Answer 4

Major surgery

> 65 years of age

Symptomatic patients with a history of rheumatic fever, diabetes, cardiovascular, renal and cerebrovascular disease, with and without severe respiratory problems.

Question 5

Indications for CXR

Answer 5

Cardiac failure

Severe COPD

Acute respiratory symptoms

Pulmonary cancer

Metastasis

Effusions

At risk of active pulmonary tuberculosis

Question 6

Urine dip

Answer 6

Should be done for everyone

Question 7

LVEF <30%

Answer 7

= poor outcome

Question 8

ACE inhibitors and ARBs

Answer 8

Omitted 24 hours pre-op

Reintroduced as and when

Question 9

Stopping warfarin

Answer 9

5 days before

+/- LMWH bridging

Question 10

Stopping DOAC

Answer 10

48 hours before

Question 11

Pacemakers

Answer 11

Mono-polar can be deteched as VF

Must turn off overpace and cardioversion pre-op
(and turn it back on again after)

or
Convert to ‘ventricle paced, not sensed with no response to sensing’ (VOO) mode

Question 12

Medications and NBM

Answer 12

Patients can continue to take their specified routine medications with sips of water in the NBM period

Question 13

BMI <15

Answer 13

Nutritional support for a minimum of 2 weeks before surgery is required to have any impact on subsequent morbidity

Question 14

Perioperative sleep apnoea prediction (P-SAP)

Answer 14

6 weeks CPAP pre-op improves outcomes

Statin for increased cholesterol

Question 15

HbA1c target

Answer 15

<69 pre-op

Question 16

Diabetic medication

Answer 16

AM list
-omit morning dose and don’t eat breakfast

PM list
-can have short acting insulin OR regular oral anti-hyperglycaemic WITH breakfast

Major surgery –> sliding scale

Question 17

Oral contraceptives

Answer 17

Progesterone only can be continued

Oestrogen-contianing - stopped 4 weeks pre-op

Question 18

Stopping anti-platlets

Answer 18

7 days for aspirin

10 days for clopidogrel

If the thrombotic risks are perceived to be highand the patient is undergoing surgery with a high risk of bleeding, aspirin alone should be continued

Question 19

Anti-epileptics

Answer 19

Continue

Question 20

Lithium

Answer 20

Stop 24 hours pre-op

Need pre-op levels to exclude toxicity

Question 21

One metabolic equivalent

Answer 21

One MET is equivalent to the oxygen consumption of an adult at rest (~3.5 mL/kg/min)

Question 22

PEEP

Answer 22

Positive end expiratory pressure (PEEP) is often applied to help maintain functional residual capacity (FRC).

This avoids lung collapse by opening collapsed alveoli, and maintains a greater area of gas exchange so reducing vascular shunting

Question 23

Causes methaemoglobinaemia

Answer 23

Prilocaine

Question 24

Bupivicaine

Answer 24

Bupivacaine overdose causes treatment-resistant ventricular arrhythmia and cardiac arrest

Question 25

Contraindications to adrenaline plus LA

Answer 25

The use of adrenaline is contraindicated in patients with cardiovascular disease, those taking tricyclic and monoamine oxidase inhibitors and in end-arterial locations.