Pre-op Assessment Flashcards
What are examples of traumas of surgery the body endures?
- Includes:
- Stress response
- Fluid shifts
- Blood loss
- Cardiovascular, respiratory, renal and metabolic stress
We give the patient anaesthesia:
- GA
- Drug induced reversible coma
- CNS, cardiac and respiratory depression
- Drug interaction
- Regional anaesthesia
- Profound sympathectomy
- Neurological sequalae
What needs to be considered in the pre-op assessment?
- Patient
- Known co-morbidities
- Unknown pathologies
- Nature of surgery
- Anaesthetic techniques
- Post-op care
Describe the anaethetists role pre-op?
Includes:
- Assess
- Identify high risk
- Optimise
- Minimise risk
- Inform and support patients decisions
- Consent
What we can do depends on what time available:
- Could be planned elective surgery, urgent surgery or emergency surgery
What is the purpose of the pre-op assessment?
Purpose of pre-op assessment is for optimisation to reduce risks in surgery:
- Optimal medical control
- Most medications continue as normal, especially inhalers, anti-anginals and anti-epileptics
- Exceptions are possibly anti-diabetic medication and anticoagulants
- Optimal lifestyle
- Smoking, alcohol, obesity, exercise
What medications must continue as normal before an operation and what usually dont?
- Most medications continue as normal, especially inhalers, anti-anginals and anti-epileptics
- Exceptions are possibly anti-diabetic medication and anticoagulants
What are important lifestyle factors that are assessed pre-op?
- Smoking, alcohol, obesity, exercise
What are the different aspects of the pre-op assessment?
- History
- Examination
- Investigations
What are important aspects of the history pre-op?
- Known co-morbidities – severity, control
- Unknown co-morbidities – systemic enquiry, clinical examination
- Ability to withstand stress – exercise tolerance, reason for limitation, carido-respiratory disease
- Drugs and allergies
- Previous surgery and anaesthesia
- Potential anaesthetic problems – airway, spine, reflux, obesity, family history
What investigations are done in the pre-op assessment?
Particularly interested in CVS and respiratory system
What is considered when choosing which investigations to do pre-op?
- Sensitivity and specificity
- Target those at risk
- Iatrogenic harm of over-investigation
- NICE guidelines – ASA grade, surgery grade, co-morbidities
Describe ASA grading?
Other than ASA grading, what are some other risk assessment tools?
- Other risk assessment tools: POSSUM scores, STOP-BANG questionnaire, GUPTA perioperative cardiac risk, cardiac risk index (used often, 1 point for each condition where 2 or more points means most at risk)
Describe the cardiac risk index?
1 point for each condition where 2 or more points means at risk
Describe exerice tolerance (METS)?
