Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia > Pre -Op Assessment > Flashcards

Pre -Op Assessment Flashcards

1
Q

When should Pre-Op Assessment be done?

A

At least 24hours before a surgical procedure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why do we do Pre-Op assessment (9).

A
  1. To identify existing medical problems, their management and any implications.
  2. To understand all surgical and procedural problems and their implications.
  3. To determine current drug therapy.
  4. To identify risk factors for morbidity and mortality and if possible apply measures to reduce risks, e.g. cardiac, respiratory, aspiration, renal, haematological, endocrine.
  5. To prepare an appropriate anaesthesia and analgesia plan including regional technique, airway management and invasive monitoring.
  6. To plan postoperative recovery, e.g. HDU or ICU.
  7. To obtain consent for the plan and discuss routine and specific risk-benefits and address concerns.
  8. If necessary, to seek a second opinion or advice from another specialist or refer to another specialist.
  9. To prevent on-the-day cancellations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does a Pre-op Assessment involve?

A

1.History Taking
2.Physical Exam
-General
-Airway
-ASA Physical Classification
3.Lab investigations
4.Management Plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What aspects of history taking does one focus on?

A

Brief History
Past Medical history
Past Surgical History
Past Anesthetic history
Drug History
Family history
Social History

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main points covered under Brief and Past Medical History?

A

Brief
1.Presenting complaint
2.Procedure to be done
3.Confirm site of the procedure

Past medical history
1.CVS: Hypertension, history of an acute cardiac event during anaesthetic procedure
2.Respiratory disease
3.Renal disease; anaemia, coagulopathies
4.Endocrine disease; DM, thyroid disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the main points covered under the Past Surgical History?

A

Previous operations
What procedures
Site
Reason
complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the main points covered under Past Anesthetic History?

A

Any anaesthesia prior to this
Any complications(Allergies, difficult airway, difficult IV access)
Well being post operatively
Post op nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the main points covered under past drug history?

A

Any drug allergies
Any current medications
Any medic alert bracelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is drug history important?

A

Some meds must be stopped, altered prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What key points are covered under family history?

A

Conditions that lead to muscle rigidity despite neuro muscular blockade
Malignant hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define Malignant Hyperthermia?

A

Malignant hyperthermia (MH) is a hereditary disorder of skeletal muscle that classically presents as a hypermetabolic response to halogenated anesthetic gasses and/or the depolarizing muscle relaxant succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What key points are covered under social history?

A

Smoking
Alcohol
Substance abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are two aspects of physical examination are assessed ?

A

1.General Examination
2. Airway Examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is airway examination done?

A

To assess how difficult intubation will be.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the acronym used to assess airway and what does it stand for?/

A

LEMON
Look externally
Evaluate; the 3-3-2 rule
Mallampati
Obstruction
Neck mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the aspects we look out for when looking at the patient?(8)

A

-We look at what is on and around the patient.
- Obesity/overweight
Short neck
Prominent upper incisors
Dentures
Burns
Facial trauma
Stridor
macroglossia

17
Q

Describe the 3-3-2 rule?

A

3 fingers of the patient fit between incisors
3 fingers from the tip of the chin (mentum) to the hyoid bone
2 fingers between hyoid bone and superior thyroid notch

18
Q

Why is the mallampati score used for?

A

To describe the relative size of the base of the tongue compared to the oropharyngeal opening in hopes of predicting the difficult airway.

Helps assess how easily you can access oropharynx

Also helps check mandible mobility

19
Q

Describe the mallampati Score?

A

Class I = visualize the soft palate, fauces, uvula, anterior and posterior pillars.

Class II = visualize the soft palate, fauces and uvula.

Class III = visualize the soft palate and the base
of the uvula.

Class IV = soft palate is not visible at all.

20
Q

What are some of things that could cause an obstruction in a patient?

A

Vomitus
Teeth
Dentures
Tumours
Abscesses
Inflamed epiglottis
Expanding hematoma

21
Q

How do you assess for neck mobility?

A

Measure from the upper edge of thyroid cartilage to the mentum while the neck is fully extended
A short thyro-mental equals an anterior pharynx
More than 7cm means easier intubation

22
Q

What classification is used in the Pre-Op assessment?

A

The ASA Physical Status Classification

23
Q

How long has the system been in use for ?

A

60 years

24
Q

What is the purpose of the classification system?

A

The purpose of the system is to assess and communicate a patient’s pre-anaesthesia medical co-morbidities.
It does not predict the perioperative risks, but used with other factors e.g, type of surgery, it can be helpful in predicting perioperative risks

25
Q

Describe the ASA Grading system using the definition? Give an adult, pediatric and obstetric example.

A

1- A normal healthy patient
2-A patient with mild systemic disease
3- A patient with severe systemic disease
4-A patient with severe systemic disease that is a constant threat to life
5-A moribund patient who isnot expected to survive without the operation
6- A declared brain-dead patient whose organs are being removed for donor purposes

26
Q

What do Pre-Op investigations depend on?

A

1.co-morbidities
2.Age
3.Type of procedure

They should not be routinely done

27
Q

What Pre-Op investigations are done?

A

FBC
Electrolytes and Urea
LFTS
Clotting profile
Imaging; X-Rays, ECG

28
Q

How do tests for a minor surgery differ between ASA1/2 and ASA3.

A

For ASA1/2 no test is routinely done
For ASA 3 -
Renal Function is considered in patients at risk of AKI
ECG- is done if it has not be done in 12 months

29
Q

How do tests for a major surgery differ between ASA1 /2 AND 3

A

ASA1 -
FBC- is routinely done
Renal Function tests- In patients at risk of AKI i.e intraperitoneal surgery, CKD, DM, Heart failure, age
ECG-In patients aged over 65 if no ECG in last 12 months

ASA 2-
FBC,RFTs and ECG is always done

ASA 3-
FBC,RFTS,ECG is always done
Coagulation study - in patients with chronic liver disease
Spirometry- done if respiratory disease is contributing to ASA status

30
Q

What does the management plan intel?

A

Reassure the patient
Advise
Prescribe
Refer
Observe

31
Q

How would you advise patients on their diet?

A

Kids
6hrs for solids
4hrs for breast milk

Adults
2hrs for clear fluids like water
4hrs for other fluids
6hrs for fruits/veggies
8hrs for heavy meals in adults

32
Q

What medication is usually stopped Pre-Op?

A

Clopidogrel
Hypoglycaemics
OCPs
Warfarin

33
Q

When is Clopidogrel stopped?

A

7days prior

34
Q

When are OCPs stopped and why?

A

4weeks prior
They cause clots?

35
Q

When is warfarin stopped?

A

5days prior

36
Q

When are hypoglycemic stopped?

A

Metformin -48hrs prior
Th rest- they can take the day before but not the morning of the procedure

37
Q

What medications is safe to start the patients on?

A

Low molecular weight heparin
Antibiotic prophylaxis

38
Q

What are the places to dispose patients after the operation?

A

Ward, HDU, ICU

Anesthesia (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions