Pre-op Assessment Flashcards
What main things happen to the body during surgery?
- fluid shifts
- blood loss
- physiological stress response
- cardiovascular, respiratory, renal and metabolic stress
What type of procedure is a spinal anaesthetic/epidural?
Sympathectomy - when a nerve is cut/blocked to stop feeling.
What is neurological sequelae?
Complications after damage to the neurological system
Results in: cognitive, sensory and motor defects (sometimes seizure and emotional instability)
What is neurological sequelae?
Complications after damage to the neurological system
Results in: cognitive, sensory and motor defects (sometimes seizure and emotional instability)
where can the patient go to recieve post operative care?
simple ward care
HDU (intensive monitoring)
Critical/intensive care (for organ monitoring)
What is the aim of the anaesthetist pre-op?
assess patient identify high risk reduce risk optimise patient health inform/support patient decisions - GAIN CONSENT
What are the types of surgery where a pre op assessment can be done?
Elective surgery
urgent surgery
emergency surgery
When is the pre-op assessment done for an elective surgery?
6-8 weeks before (at pre-assessment clinic)
When is the pre-op assessment done before an urgent and emergency surgery?
only done if theres time.
Which test is best to indicate how the patient will withstand the stress of surgery?
EXERCISE TOLERANCE TEST
What can cause problems with getting an anesthetic?
Airway problems spinal deformity or previous surgery reflux (not fasting before or intestinal obstruction) obesity Malignant hyperpyrexia pseudocholinesterase deficiency
What is the ASA grade?
its a scale used to identify how fit and healthy the patient is
ASA1- healthy patient
ASA6- organ retrieval
Which risk assessment is done for pre-op assessment?
The most common in UK = revised cardiac risk index
There are many risk assessments that can be done for different things
what is the cardiac risk index?
you get a point for any of the following:
- high risk surgery
- congestive heart failure
- cerebrovascular disease
- diabetes
- renal failure
What score on the cardiac risk index leads to higher risk?
2 or more
What are the two most common risk assessment tools?
Cardiac risk index
ASA grade
What are the scores for the exercise tolerance test?
2(bad) -9 (good)
5 or less = increased risk of mortality
How is the exercise tolerance (METs) scored?
can the patient do varioys activities without getting breathless
(increasing difficulty = increasing score)
What is the gold standard fitness test?
cardiopulmonary exercise testing (CPET)
Which lifestyle factors cause increased risk of surgery?
smoking
alcohol
obesity
What is done when a smoker goes for pre-op assessment?
ALWAYS guided towards smoking cessation
What complications does smoking cause regarding surgery?
risk of respiratory complications
poor wound healing
increased chest infections post operatively
(lots of surgeons refuse to operate on smokers - wont heal)
What complications does alcohol cause regarding surgery?
increased post op infections and septic shock
post op infections and morbidities = DOSE DEPENDANT
What does reducing alcohol do regarding surgery?
Complications are dose related
Reducing alcohol;
WILL reduce post-op infection
WONT reduce mortality (remains the same)
What is pre-habilitiation?
An exercise programme by macmillan - can be done before sugery
What does 1 increase in MET equal?
15% reduction in mortality risk
What is done during emergency surgery for patient?
Monitor BP using arterial line
Monitor arterial BG
Post op care is in HDU or ICU
Which medications are most important to CONTNUE before surgery?
Anti-anginals
anti-epileptics
inhalers
Which medications might need to be stopped before surgery?
Anti-diabetic medication
Anticoagulants
