Pre-op Assessment Flashcards
What pertinent history is important in pre-op?
Normal medical history Allergy Previous anaesthesia Social Nil per os
Who are the starved patients who may still have potentially full stomachs?
GIT obstruction pregnant Ascites Obesity Diabetics with automatic neuropathy Uraemia in CRF
That is important in pre-op optimization?
Fluid balance Electrolyte disorder (K and Na) Anaemic Hb7-9 Infections Bronchospasm (asthma/COPD) Cardiac failure Diabetes (glucose
Who does a consent form need to be signed by?
Patient, doctor and 2 witnesses
Aim of pre-operative assessment?
Presence of disease and extent and severity
Risk factors known to be associated with increased morbidity and mortality
Current therapy and review it
Need for any pre-operative optimisation
Premed
Peri-op plan
Examination and special investigations of patient?
General
Airway: face, mouth, neck and trachea
Breathing: tachypnoea, pyrexia, cyanosis, clubbing, sputum production, percussion and auscultation of chest
(Special investigations: CXR, ECG, ABG, PFTs)
Circulation: pulse, JVP, signs of CF, BP (8-10)
Further systemic review:
Resp and CVS
Renal and hepatic
Musculoskeletal abnormalities
Examine for potential difficulties: monitoring in obesity, venous or arterial access, RA (look at back)
What pre medication is given?
Anxiolysis and sedation: benzodiazepines
Analgesia: opiates, paracetamol
Anti-emetics: phenothiazine, dexamethasone
Anti-sialogogue: anticholinergics, phenothiazine
Protection from aspiration:
Acid aspiration: sodium citrate, metoclopramide, H2 receptor anatagonists, PPI (omeprazole)
Cardiac ischaemia and hypertension: BB
Bronchospasm: B agonists
DVT: heparin TED stockings calf compressions devices
How is anti-diabetic, failure and hypertensives used in anaesthetics?
Insulin sliding scale, stop oral hypoglycaemics day before theatre
Digoxin, diuretics, K supplements, always check electrolytes
Diuretics BB, Ca channel blockers
How are steroid, asthma and NSAIDS are management pre op?
If on >5mg prednisone for > 3months consider hydrocortisone supp for HPA suppression from steroids and inability to mount reponse to surgery
Continue asthma tx right up to surgery. Inhalers, reg nebs, theophylline
Consider stopping before surgery or where any effect on coagu my be critical (airway surgery, neurosurgery)
What is the pre-op management of statins ARVs and anticoagulants?
Don’t stop statins peri-op (anti-inflam)
Don’t stop ARVs
Stop warfin 3 days pre op and check INR
What is the management of psychiatric drugs, oral contraceptives, and nutriceuticals pre-op?
May psy drugs are enzyme inducers/ inhibitors
Increased risk of DVT
Nutriceuticals: ask about complementary drugs
What is classification of physical status?
The American society of Anesthesiologists (ASA) grading
Patients are graded according to their physical condition after the pre-op evaluation
Class 1- normal healthy patient
Class 2- a patient with mild systemic disease
Class 3- a patient with severe systemic disease
Class 4- a patient with severe systemic disease that is a constant threat to life
Class 5- a moribund patient who is not expected to survive with or without the operation (emergency= E)
Class 6- a declared brain-dead patient who organs are being removed for transplant
Hypertensive patient need what tests?
Hb, U&E, ECG, urinalysis
Diastolic >115mmhg- referee to physicians at least 2 weeks before elective surgery
Which patients need aneaethetic consultation?
Severe COPD Previous lung surgery Urgent surgery with a DBP > 115 Unstable or frequent angina MI in past 6 months Cardiomyopathy Previous cardiac surveyed Airway problems
