pre-op assessment Flashcards
trauma of surgery
stress response
fluid shifts
blood loss
cardiovascular, respiratory, renal and metabolic stress
considerations
patient: known co-morbidities and unknown pathologies
nature of surgery: toe-nail removal vs major cardiac surgery
anaesthetic techniques
post-op care: normal ward, ICU, organ support etc.
anaesthetist role pre-op
assess identify high risk optimise (patient condition) minismise risk inform and support patient decisions consent
why anaesthetist pre-op assessment
reduces: anxiety delays cancellations complications length of stay mortality
when does pre-op assessment take place: elective planned surgery
primary care - GP can start optimising chronic disease control
pre-assessment clinic - usually 6/8wks pre-op
when does pre-op assessment take place: urgent surgery
e.g. Ca op in next 2-3wks
still has chance for assessment and some optimisation
when does pre-op assessment take place: emergency
still need to assess them and tailor anaesthetic
history taking points to cover during pre-op assessment
known co-morbidities un-known co-morbidities (systemic enquiry) ability to withstand/tolerate stress drugs + allergies prev surgery and anaesthesia potential anaesthetic problems
potential anaesthetic problems
airway: will there be any difficulties in need to bag mask/intubate
spine: any previous surgery/deformities that would make epidural difficult/contraindication
reflux: risk aspiration
obesity
reasons for pre-op investigations
detect unknown conditions diagnose suspected conditions severity of known disease establish a baseline detecting complications assessing risk guiding management documenting improvement
pre-op investigations: CVS
ECG exercise tolerance test echo myocardial perfusion tets stress echo cariac catheritisation CT CA
pre-op investigations: respiratory
saturations ABG CXR peak flow FVC/FEV gas transfer CT chest
optimising medical control: ex conditions
htn IHD heart failure asthma COPD diabetes epilepsy
optimising medical control: lifestyle
smoking
alcohol
obesity
exercise
high risk emergency patient
informed consent anaesthetic plan invasive monitoring senior management post-op critical care
