Pre op assessment

Question 1

What are the elements of the pre op consultation?

Answer 1

• like a 10 minute long case with a plan for mx
  
  • hx (including old anaesthetic notes)
    
    • HOPC (emegency or elective)
    • past med (medical problems, previous anaesthesia)
    • fam hx (anaesthetic problems)
    • meds (OTC and herbal meds)
    • social hx (supports at home)
    • allergies
    • systems review
    • functional state (exercise tolerance)
    • fasting status
  • examination
    
    • vital signs
    • ABCDE
    • CVS- veins, cardiac rhythm, murmurs
    • Resp- Airway, chest
    • NS- block site, raised ICP, decreased consciousness
  • investigations
    
    • not necessary in those who are fit and young (<60)
    • patients with pre-exisiting medical conditions should have ix relevant to their illness
    • UEC, LFT, blood sugars, HBA1c, ECG, CXR, Coagulation screen
  • management plan
  • give instructions (stop smoking, fasting)
  • consent
  • prescription (what to take and what to withhold)

Question 2

What are some conditions that require assessment and optimisation prior to surgery?

Answer 2

• CVS
  
  • uncontrolled IHD, CCF, HTN, arrhythmia, symptomatic valvular heart disease, pacemakers
• resp
  
  • poorly controlled asthma, COPD with dyspnoea at rest, smoking
• Endocrine
  
  • diabetes, thyroid disease
• renal disease
  
  • patients on dialysis
• haematologic disorders
  
  • anaemia, anticoagulation

Question 3

different types of anaesthetic flow chart

Answer 3

Question 4

What are some risks of anaesthesia?

Answer 4

• minor
  
  • failed IV access
  • cut lip, dental injury, sore throat
  • headache
  • PONV
• major
  
  • aspiration of gastric content
  • hypoxic brain injury
  • MI, stroke
  • nerve injury
  • chest infection
  • death

Question 5

List some drugs that are considered pre-medication?

Answer 5

• anxiolysis
• amnesia
• analgesia
• antacid prophylaxis
• antisialogogue
• medications to control pre-existing medical condition

Question 6

How long before surgery should you stop warfarin?

Answer 6

stop warfarin 5 days before and check INR before surgery

may need bridging therapy with clexane when warfarin is ceased, if there is a high risk of thrombosis

Question 7

What do you do if the patient is on warfarin and they need emergency surgery?

Answer 7

reverse warfarin with prothrombinex 50IU/kg

may also need vit K and Fresh frozen plasma