PRE-OP ASSESSMENT

Question 1

What are the three surgical timescales?

Answer 1

pre-operative, intra-operative,post-operative

Question 2

(What is perioperative?)

Answer 2

All three stages of surgery

Question 3

What is major surgery?

Answer 3

Where they open you up, invasive surgery. On major organs

Patients usually put under general anaesthesia, given respiratory assistance, can carry a degree of risk.

Question 4

What are the three different types of surgery?

Answer 4

Non-invasive, invasive. Open surgery, key hole surgery, micro surgery

Question 5

What are the advantages of laparoscopic surgery compared to open surgery?

Answer 5

Quicker healing time, short stay at hospital, less risk of bleeding, less scarring.

Question 6

What are the different types of lung surgery?

Answer 6

Lobectomy, wedge resection, pneumonectomy, sleep lobectomy, segment resection (segmentectomy)

Question 7

What are the 4 criteria’s for adequate perioperative lung function (in the detail)?

Answer 7

1. Sufficient oxygen into the body to oxygenate blood- SPO2 should be >90%
2. Elimination of CO2 to prevent CO2 accumulation- high co2 may lead to coma
3. Generate a productive cough to prevent mucus accumulation, atelectasis, infection, pneumonia etc- reduced cough flow may suggest inability to clear secretions.
4. Able to significantly increase minute ventilation to compensate for factors such as:

 ↑ Post op metabolic rate  ↑ Body temperature  Possible infection

Question 8

What is the calculation for MMV?

Answer 8

MMV= Fev x 35

Question 9

Which values indicate a high risk for surgery? (For Mvv)

Answer 9

Around <30-40 l min is high risk

Question 10

Why assess risks?

Answer 10

To see if the patient is operable on with as less complications as possible. Modern factors to decrease risk.

Question 11

What are the non-pulmonary, pulmonary and cardiac pulmonary risk factors?

Answer 11

Non-pulmonary- site of surgery, duration, laparoscopic approach, aortic stenosis, age

Pulmonary-COPD, smoking, American society of anaesthesiology score.

Cardiac- congestive heart failure, MI, AORTICSTENOSIS

Question 12

What are postoperative pulmonary complications?

Answer 12

Resp infection, Pulmonary oedema, Pneumonia, Resp failure, Pulmonary embolism, Tracheobronchitis

Question 13

How can risk be reduced?

Answer 13

Weight reduction, reducing or stopping smoking, antibiotics

Question 14

What pre-op test may be used?

Answer 14

Pulmonary lung function test, CPET, Oximetry (SpO2) / blood gas analysis (PO2, PCO2)

Question 15

What is the equation for estimated post-op FEV1?

Answer 15

Prefev1= ((19-no.lobes)/19))

Question 16

What are the advantages of CPET?

Answer 16

• Stresses the entire cardiopulmonary & oxygen delivery systems
• Assesses the reserve that may be required after surgery
• Can assess factors that may go unrecognised:–e.g. impaired joint motility, muscle weakness, leg pain
• Widely used in assessing lung disease:–Occupational impairment/disability–Pulmonary rehabilitation

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Question 17

Which peak VO2 number indicates high risk for surgery?

Answer 17

> 15 (L/min)