Pre-op assessment Flashcards
Anaesthetis role pre-op
Assess Identify high risk Optimise Minimise risk Inform and support patient decisions Consent
The traumas of a surgery
Stress response
Fluid shifts
Blood loss
Cardiovascular, renal and metabolic stress
Pre-op assessment involves…..
History
Examination
investigations
History of pre-op assessment involves….
Known co morbidities (severity, control) Unknown co morbidities (systemic exam) Ability to withstand stress - Exercise tolerance - METs - Reason for limitation - cardio-resp disease Drugs and allergies Previous surgery and anaesthesia Potential anaesthetic problems
What are potential anaesthetic problems?
Airway Spine Reflux Obesity Rarities/FH - malignant hyperpyrexia - cholinesterase deficiency
MET questions for exercise tolerance
Walk around the house = 2METs
Do light housework = 3 METs
Stairs / hill = 4 METS
Walk on the flat at brisk pace = 6 METS
Play golf, mountain walk, any form of exercise = 7 METS
Run a short distance = 8 METS
Do either strenuous exercise or heavy physical work = 9 METS
ASA grading for patients
ASA1 = otherwise healthy patient ASA2 = mild to moderate systemic disturbance ASA3 = Severe systemic disturbance ASA4 = moribund patient ASA5 = organ retrieval
Cardiac risk index looks at…
High risk surgery Ischaemic heart disease Congestive heart failure Cerebrovascular heart failure DM Renal failure
Cardiovascular pre op investigations
ECG Exercise tolerance test ECHO myocardial perfusion scan stress ECHO cardiac catheterisation CT coronary angiogram
Respiratory investigations pre - op
Saturations ABG CXR Peak flow measurements FVC/FEV Gas transfer CT chest
Pre-op medications
MOST continue as normal
What medications are especially continued as normal pre-op?
Inhalers
Anti-anginals
Anti-epileptics
What medications are NOT continued normally pre-op?
Anti-diabetic medication
Anticoagulants
What has to be done after a pre op assessment?
Optimal medical control of conditions
