Pre-op assessment and planning Flashcards
Anaesthetic perioperative assessment Fasting guidelines Operative antibiotic prophylaxis
Name three features of pre-op assessment
- Operative fitness- CDV, comorbidities
- Drugs
- Consent
- History- MI, HTN, complications of anaesthesia
- Intubation assessment
- Site correctly marked
Name two complications of anaesthesia
DVT, anaphylaxis
Name two drug classes that should be reviewed before surgery
- Anticoagulants- risk of haemorrhage and thrombosis
- Antiepileptic drugs- continue, give IV or NGT
- Oral CP/HRT- stop 4 weeks before major surgery
- Beta blockers- fine to continue
Name three pre-op investigations
Bloods CXR ECG Echo MRSA swabs
Aside from routine bloods, name two other specific blood tests that can be carried out
Cross-match
TFTs
Name two pre-op interventions/preparations
NBM
Bowel prep
Prophylactic abx
DVT prophylaxis
What are the guidelines on NBM before surgery?
NBM >2 hr for fluids, >6hr for solids
Name two surgeries in which prophylactic antibiotics are indicated
GI surgery
Joint replacement
Which antibiotics are given prior to appendectomy
cef + met
If patient is med-high risk for DVT, which drug should you commence them on prior to surgery?
enoxaparin- LMWH -> binds to and potentiates antithrombin III (a circulating anticoagulant) to form a complex that irreversibly inactivates clotting factor Xa.
What are ASA grades?
Physical status classification system: the purpose of the system is to assess and communicate a patient’s pre-anesthesia medical co-morbidities.
How many ASA grades are there?
I-V (VI= brain dead)
Patient has systemic disease which is a constant threat to life. What ASA grade are they?
grade IV
- Normally healthy
- Mild systemic disease
- Severe systemic disease that limits activity
- Systemic disease which is a constant threat to life
- Moribund: not expected to survive 24h even c¯ op
