Pre-op Assessment Flashcards
what is the anaesthetists role preop?
Assess Identify high risk Optimise Minimise risk inform and support patient decision consent
as a result of preop what reduces?
anxiety delays cancellations complications length of stay mortality
what is the trauma of surgery?
stress response
fluid shifts
blood loss
cardio, resp, renal and metabolic stress
what is important in the history during a pre-op assessment?
drugs and allergies
previous surgery and anaesthesia
potential anaesthetic problems - airway, spin, reflux, obesity
FHx - malignant hyperthermia, cholinesterase deficiency
Known co-morbidities - severity, control
unknown co-morbidities - systemic enquiry, clinical exam
ability to withstand stress - exercise tolerance
why are investigations carried out in the preop assessment?
detect unknown conditions diagnose suspected conditions severity of known disease establish baseline detecting complications assessing risk guiding management documenting improvement sensitivity and specificity target those at risk iatrogenic harm of over-investigation
what cardiovascular tests could be performed as part of pre op?
ECG exercise tolerance test echo myocardial perfusion scan stress echo cardiac catheterisation CT coronary angiogram
what respiratory tests could be performed as part of pre op?
saturations ABG CXR peak flow FVC/FEV gas transfer CT chest
what conditions should you ensure there is optimal control over during pre-op?
hypertension ischaemic heart disease heart failure asthma COPD diabetes epilepsy
what medications should definitely be continued in preop?
inhalers
antianginals
antiepileptics
what medications should not be continued preop?
anti-diabetic
anticoagulants - but depends
