Pre-op Assessment Flashcards
What is the aim of the pre-op assessment?
To identify patients who are most at risk of the traumas of surgery and putting measures in place to minimize this risk
What are the main traumas of surgery?
- Stress response
- Fluid shifts
- Blood loss
- Cardiovascular, respiratory, renal and metabolic stress
What considerations should be made in the pre-op assessment?
- Patient (Known co-morbidities, unknown pathologies)
- Nature of surgery
- Anaesthetic techniques
- Post-op care
What enquiries should be made in a pre-operative history?
- Known comorbidities
- Systematic enquiries and examination to uncover unknown conditions
- Ability to withstand stress- exercise tolerance, cardio-respiratory disease etc
- Drugs and allergies
- Previous anaesthetic problems
- Potential anaesthetic problems (airway, spine, reflux, obesity)
What are the aims of pre-operative investigations?
- Detect unknown conditions
- Diagnose suspected conditions
- Severity of known disease
- Establishing a baseline
- Detecting complications
- Assessing risk
- Guiding management
- Documenting improvement
How are the ASA grades assigned?
ASA1 Otherwise healthy patient ASA2 Mild to moderate systemic disturbance ASA3 Severe systemic disturbance ASA4 Life threatening disease ASA5 Moribund patient ASA6 Organ retrieval
How is a cardiac risk index score calculated?
Each of the following comorbidities gives a point: • High risk surgery • Ischaemic heart disease • Congestive heart failure • Cerebrovascular disease • Diabetes • Renal failure Above 4 corresponds to a high risk of having a cardiac complication following surgery, 2-3 moderate risk, and 1 point is low risk.
What chronic conditions should be optimally managed to reduce surgical risk?
Hypertension Ischaemic heart disease Heart failure Asthma COPD Diabetes Epilepsy
What lifestyle changes can minimise surgical risk?
Smoking
Alcohol
Obesity
Exercise
How should medications be altered pre-operatively?
Most medications should be kept as normal pre-operatively, exceptions being anti-diabetic medication and anti-coagulation.
