Pre-op Assessment Flashcards
3 components of pre-op assessment
- Hx
- Examination
- Investigations
What 3 types of medications do patients continue to take pre-op and what 2 do they stop
Stop
- Anticoagulants
- Anti-diabetic medication
Most medications continue as normal but especially:
- Inhalers
- Anti-anginals
- Anti-epileptics
6 roles of an anaesthetist
- Planned/emergency surgery
- Peri-operative medicine
- Analgesia
- Resuscitation + stabilisation
- Critical care
- Hyperbaric medicine
Anaesthetists’ role pre-op
- Assess
- Identify high risk
- Minimise risk
- Inform + support patients decisions
- Gain consent
- Optimise
Why do a pre-op assessment
Reduces:
- Mortality
- Complications
- Length of stay
- Cancellations
- Delays
- Anxiety
3 types of surgery that utilise a pre-op assessment
- Elective planned surgery (primary care/pre-assessment clinic)
- Urgent surgery
- Emergency surgery
Describe the trauma of surgery
- Stress response
- Fluid shifts
- Blood loss
- CVS, resp., renal and metabolic stress
2 broad categories of anaesthesia
- General
- Local
Effect of general anaesthesia
- Drug induced, reversible, coma
- CNS, cardia and resp. depression
- Drug interacions
Effect of local anaesthesia
- Profound sympathectomy
- Neurological sequelae
4 Considerations during pre-op assessment
- Patient (known/unknown morbidities)
- Nature of surgery
- Anaesthetic techniques
- Post-op care
Components of a pre-op Hx
- Known comorbidities (severity + control)
- Unknown comorbidities (exam + systemic enquiry)
- Ability to withstand stress (exercise tolerance test, reason for limitation, cardio-respiratory disease)
- Drugs + allergies
- Previous surgery + anaesthesia (any problems)
- Potential anaesthetic problems
5 potential anaesthetic problems
-Airway
-Spine
-Reflux
-Obesity
-Rarities/FHx
Malignant hyperthermia
Cholinesterase deficiency
8 components of the exercise tolerance test
Can you do the following without getting breathless
- Walk around the house (2 METs)
- Do light housework (3 METs)
- Walk 100-200m on the flat (4 METs)
- Climb a flight of stairs or walk up a hill (5 METs)
- Walk on the flat at a brisk pace (6 METs)
- Any form of exercise (7 METs)
- Run a short distance (8 METs)
- Do strenuous or heavy physical work (9 METs)
Describe the ASA grading system and its 6 levels
Used to assess a patient’s fitness prior to surger
- ASA 1, Otherwise healthy patient
- ASA 2, Mild-moderate systemic disturbance
- ASA 3, Severe systemic disturbance
- ASA 4, Life threatening disease
- ASA 5, Moribund (not expected to survive surgery) patient
- ASA 6, Organ retrieval
