Pre-op Assessment and Premedication

Question 1

What is the main aim of a preoperative visit?

Answer 1

To assess the patient’s fitness for anaesthesia.

Question 2

Who should ideally perform the preoperative visit?

Answer 2

An anaesthetist, preferably the one administering the anaesthesia.

Question 3

What are the key objectives of the preoperative visit?

Answer 3

Determination of anaesthetic technique, allaying anxiety, risk assessment, optimization, prescribing premedication, obtaining informed consent.

Question 4

How can an anaesthetist help patients with coexisting illnesses before surgery?

Answer 4

By optimizing treatment, seeking advice from specialists, and improving the patient’s condition before surgery.

Question 5

What are the three situations that require special arrangements for preoperative visits?

Answer 5

Patients with complex medical problems, surgical emergencies, and day-case patients.

Question 6

What is the importance of taking a full history and examining each patient during a preoperative visit?

Answer 6

To identify any medical history that could impact anaesthesia and to optimize the patient’s condition.

Question 7

What should be enquired about a patient’s previous anaesthetics and operations?

Answer 7

Inherited or family diseases, difficulties with previous anaesthetics, nausea, vomiting, awareness, and postoperative complications.

Question 8

What specific questions should be asked regarding the cardiovascular system during a preoperative visit?

Answer 8

Angina, myocardial infarction history, heart failure symptoms, valvular heart disease, prosthetic valves.

Question 9

Why is it important to postpone elective surgery for patients who had a recent myocardial infarction?

Answer 9

To reduce the risk of perioperative re-infarction.

Question 10

What are the risks associated with untreated or poorly controlled hypertension during surgery?

Answer 10

It can lead to exaggerated cardiovascular responses, increasing the risk of myocardial ischemia.

Question 11

What conditions are considered active cardiac conditions that require special attention preoperatively?

Answer 11

Unstable angina, recent MI, decompensated heart failure, significant arrhythmias, severe valvular disease.

Question 12

What are some common pre-existing respiratory conditions that need to be evaluated preoperatively?

Answer 12

Chronic obstructive lung disease, asthma, upper respiratory infections, and risk of postoperative chest infections.

Question 13

How can other medical conditions like indigestion or rheumatoid disease affect anaesthesia management?

Answer 13

They may indicate a need for special positioning, airway management, or additional monitoring.

Question 14

What considerations should be made for diabetic patients undergoing surgery?

Answer 14

They have increased risks of ischaemic heart disease, renal dysfunction, and complications.

Question 15

How does chronic renal failure affect anaesthetic management?

Answer 15

It can cause electrolyte abnormalities, altered drug excretion, and restrict anaesthetic choices.

Question 16

Why is family history important in a preoperative assessment?

Answer 16

To identify inherited conditions like malignant hyperpyrexia or a history of prolonged apnoea.

Question 17

What is crucial to note in a patient’s drug history and allergies?

Answer 17

Identify all medications, including prescribed, self-administered, and allergies to drugs or food.

Question 18

What information should be gathered in a social history during a preoperative visit?

Answer 18

Smoking, alcohol use, difficulty with venous access, and risk of withdrawal syndromes.

Question 19

Why is pregnancy considered a high-risk factor in preoperative assessments?

Answer 19

There is an increased risk of regurgitation and aspiration.

Question 20

What are the key components to check during a physical examination for anaesthesia?

Answer 20

Blood pressure, pulse, respiration, temperature, signs of dehydration, cyanosis, jaundice.

Question 21

What is the significance of the cardiovascular system examination before surgery?

Answer 21

Checking for pulse rate, rhythm, jugular venous pressure, and presence of any abnormal signs.

Question 22

What should be examined in the respiratory system before surgery?

Answer 22

Inspection for chest shape, cyanosis, signs of distress, cough, and auscultation of breath sounds.

Question 23

What is the importance of airway evaluation in preoperative assessments?

Answer 23

To predict potential difficulties with intubation and airway management.

Question 24

How can an anaesthetist predict a difficult intubation?

Answer 24

By observing anatomical features, performing bedside tests, and imaging.

Question 25

What are some of the bedside tests used to assess the airway?

Answer 25

Wilson’s score, Mallampati criteria, thyromental distance.

Question 26

What are some special investigations needed in preoperative assessment?

Answer 26

Baseline investigations like FBC, E/U/Cr, chest X-ray, ECG, and specific tests based on patient history.

Question 27

When is a medical referral necessary before surgery?

Answer 27

When optimization of coexisting conditions is necessary or in high-risk cases.

Question 28

What cardiovascular conditions might necessitate a medical referral?

Answer 28

Uncontrolled hypertension, symptomatic ischaemic heart disease, uncontrolled arrhythmias.

Question 29

What respiratory diseases warrant a medical referral before surgery?

Answer 29

Severe COPD, unstable asthma, bronchiectasis.

Question 30

What endocrine disorders should be managed carefully before surgery?

Answer 30

Uncontrolled diabetes, hypo/hyperthyroidism, Cushing’s, Addison’s disease.

Question 31

What haematological disorders might complicate anaesthesia?

Answer 31

Bleeding diatheses, haemoglobinopathies, polycythaemia, leukaemias.

Question 32

What is the ASA Physical Status Classification System?

Answer 32

A system that categorizes patients based on their physical status and risk.

Question 33

What are the different surgical risk classifications?

Answer 33

High-risk (e.g., major vascular), intermediate-risk (e.g., intrathoracic), and low-risk (e.g., endoscopic procedures).

Question 34

How should patients be informed about their anaesthetic options?

Answer 34

Through detailed discussions about risks, techniques, and obtaining informed consent.

Question 35

What are the fasting guidelines for patients before surgery?

Answer 35

Varies from 2 hours for clear liquids to 8 hours for solid foods.

Question 36

What are the goals of premedication in anaesthesia?

Answer 36

Anxiolysis, amnesia, anti-emetic effects, analgesia, antacid, anti-autonomic effects.

Question 37

What factors should be considered before prescribing premedication?

Answer 37

Patient's physical status, age, anxiety, type of surgery, timing, and drug allergies.

Question 38

What are the pharmacological components of premedication?

Answer 38

Anxiolytic, amnestic, anti-emetic, antacid, anti-autonomic agents.

Question 39

What drugs are commonly used for anxiolysis as premedication?

Answer 39

Benzodiazepines, phenothiazines.

Question 40

What medications are used for amnesia in premedication?

Answer 40

Lorazepam.

Question 41

What types of drugs are used as anti-emetics in premedication?

Answer 41

Dopamine antagonists, antihistamines, anticholinergics, 5-HT antagonists.

Question 42

What is the purpose of administering antacid premedication?

Answer 42

To reduce the risk of aspiration and acid-related complications.

Question 43

What medications are used as anti-autonomic agents in premedication?

Answer 43

To manage parasympathetic reflexes and excessive vagal activity.

Question 44

How can premedication facilitate the induction of anaesthesia?

Answer 44

By reducing anxiety and providing optimal physiological conditions.

Question 45

What are some considerations for patients presenting as emergencies in premedication?

Answer 45

Considerations include patients with delayed gastric emptying or in severe pain.

Question 46

How does a patient’s age affect the choice of premedication?

Answer 46

Different age groups may require different drug dosages and routes of administration.

Question 47

What are some key premedication agents for pain management?

Answer 47

NSAIDs, opioids, and local anaesthetics.

Question 48

Why might clonidine or dexmedetomidine be used as premedication?

Answer 48

For their sedative and analgesic properties, and to reduce sympathetic response.

Question 49

What is the importance of assessing a patient's airway anatomy before surgery?

Answer 49

To predict and prepare for difficult airway management.

Question 50

How do conditions like micrognathia affect airway management?

Answer 50

It may indicate challenges in airway access, requiring special techniques.