Pre -Op Assessment Flashcards
When should Pre-Op Assessment be done?
At least 24hours before a surgical procedure.
Why do we do Pre-Op assessment (9).
- To identify existing medical problems, their management and any implications.
- To understand all surgical and procedural problems and their implications.
- To determine current drug therapy.
- To identify risk factors for morbidity and mortality and if possible apply measures to reduce risks, e.g. cardiac, respiratory, aspiration, renal, haematological, endocrine.
- To prepare an appropriate anaesthesia and analgesia plan including regional technique, airway management and invasive monitoring.
- To plan postoperative recovery, e.g. HDU or ICU.
- To obtain consent for the plan and discuss routine and specific risk-benefits and address concerns.
- If necessary, to seek a second opinion or advice from another specialist or refer to another specialist.
- To prevent on-the-day cancellations
What does a Pre-op Assessment involve?
1.History Taking
2.Physical Exam
-General
-Airway
-ASA Physical Classification
3.Lab investigations
4.Management Plan
What aspects of history taking does one focus on?
Brief History
Past Medical history
Past Surgical History
Past Anesthetic history
Drug History
Family history
Social History
What are the main points covered under Brief and Past Medical History?
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
What are the main points covered under the Past Surgical History?
Previous operations
What procedures
Site
Reason
complications
What are the main points covered under Past Anesthetic History?
Any anaesthesia prior to this
Any complications(Allergies, difficult airway, difficult IV access)
Well being post operatively
Post op nausea and vomiting
What are the main points covered under past drug history?
Any drug allergies
Any current medications
Any medic alert bracelets
Why is drug history important?
Some meds must be stopped, altered prior to surgery
What key points are covered under family history?
Conditions that lead to muscle rigidity despite neuro muscular blockade
Malignant hyperthermia
Define Malignant Hyperthermia?
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
What key points are covered under social history?
Smoking
Alcohol
Substance abuse
What are two aspects of physical examination are assessed ?
1.General Examination
2. Airway Examination
Why is airway examination done?
To assess how difficult intubation will be.
What is the acronym used to assess airway and what does it stand for?/
LEMON
Look externally
Evaluate; the 3-3-2 rule
Mallampati
Obstruction
Neck mobility
What are the aspects we look out for when looking at the patient?(8)
-We look at what is on and around the patient.
- Obesity/overweight
Short neck
Prominent upper incisors
Dentures
Burns
Facial trauma
Stridor
macroglossia
Describe the 3-3-2 rule?
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
Why is the mallampati score used for?
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
Describe the mallampati Score?
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.
What are some of things that could cause an obstruction in a patient?
Vomitus
Teeth
Dentures
Tumours
Abscesses
Inflamed epiglottis
Expanding hematoma
How do you assess for neck mobility?
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
What classification is used in the Pre-Op assessment?
The ASA Physical Status Classification
How long has the system been in use for ?
60 years
What is the purpose of the classification system?
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
