Pre-op Assessment

Question 1

What main things happen to the body during surgery?

Answer 1

• fluid shifts
• blood loss
• physiological stress response
• cardiovascular, respiratory, renal and metabolic stress

Question 2

What type of procedure is a spinal anaesthetic/epidural?

Answer 2

Sympathectomy - when a nerve is cut/blocked to stop feeling.

Question 3

What is neurological sequelae?

Answer 3

Complications after damage to the neurological system

Results in: cognitive, sensory and motor defects (sometimes seizure and emotional instability)

Question 3

What is neurological sequelae?

Answer 3

Complications after damage to the neurological system

Results in: cognitive, sensory and motor defects (sometimes seizure and emotional instability)

Question 4

where can the patient go to recieve post operative care?

Answer 4

simple ward care
HDU (intensive monitoring)
Critical/intensive care (for organ monitoring)

Question 5

What is the aim of the anaesthetist pre-op?

Answer 5

assess patient
identify high risk
reduce risk 
optimise patient health 
inform/support patient decisions
- GAIN CONSENT

Question 6

What are the types of surgery where a pre op assessment can be done?

Answer 6

Elective surgery
urgent surgery
emergency surgery

Question 7

When is the pre-op assessment done for an elective surgery?

Answer 7

6-8 weeks before (at pre-assessment clinic)

Question 8

When is the pre-op assessment done before an urgent and emergency surgery?

Answer 8

only done if theres time.

Question 9

Which test is best to indicate how the patient will withstand the stress of surgery?

Answer 9

EXERCISE TOLERANCE TEST

Question 10

What can cause problems with getting an anesthetic?

Answer 10

Airway problems 
spinal deformity or previous surgery 
reflux (not fasting before or intestinal obstruction)
obesity
Malignant hyperpyrexia 
pseudocholinesterase deficiency

Question 11

What is the ASA grade?

Answer 11

its a scale used to identify how fit and healthy the patient is

ASA1- healthy patient
ASA6- organ retrieval

Question 12

Which risk assessment is done for pre-op assessment?

Answer 12

The most common in UK = revised cardiac risk index

There are many risk assessments that can be done for different things

Question 13

what is the cardiac risk index?

Answer 13

you get a point for any of the following:

• high risk surgery
• congestive heart failure
• cerebrovascular disease
• diabetes
• renal failure

Question 14

What score on the cardiac risk index leads to higher risk?

Answer 14

2 or more

Question 15

What are the two most common risk assessment tools?

Answer 15

Cardiac risk index

ASA grade

Question 16

What are the scores for the exercise tolerance test?

Answer 16

2(bad) -9 (good)

5 or less = increased risk of mortality

Question 16

How is the exercise tolerance (METs) scored?

Answer 16

can the patient do varioys activities without getting breathless

(increasing difficulty = increasing score)

Question 17

What is the gold standard fitness test?

Answer 17

cardiopulmonary exercise testing (CPET)

Question 18

Which lifestyle factors cause increased risk of surgery?

Answer 18

smoking
alcohol
obesity

Question 19

What is done when a smoker goes for pre-op assessment?

Answer 19

ALWAYS guided towards smoking cessation

Question 20

What complications does smoking cause regarding surgery?

Answer 20

risk of respiratory complications
poor wound healing
increased chest infections post operatively

(lots of surgeons refuse to operate on smokers - wont heal)

Question 21

What complications does alcohol cause regarding surgery?

Answer 21

increased post op infections and septic shock

post op infections and morbidities = DOSE DEPENDANT

Question 22

What does reducing alcohol do regarding surgery?

Answer 22

Complications are dose related

Reducing alcohol;
WILL reduce post-op infection
WONT reduce mortality (remains the same)

Question 23

What is pre-habilitiation?

Answer 23

An exercise programme by macmillan - can be done before sugery

Question 24

What does 1 increase in MET equal?

Answer 24

15% reduction in mortality risk

Question 25

What is done during emergency surgery for patient?

Answer 25

Monitor BP using arterial line
Monitor arterial BG
Post op care is in HDU or ICU

Question 26

Which medications are most important to CONTNUE before surgery?

Answer 26

Anti-anginals
anti-epileptics
inhalers

Question 27

Which medications might need to be stopped before surgery?

Answer 27

Anti-diabetic medication

Anticoagulants