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Anaesthesia > Pre-op Assessment and Premedication > Flashcards

Pre-op Assessment and Premedication Flashcards

1
Q

What is the main aim of a preoperative visit?

A

To assess the patient’s fitness for anaesthesia.

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2
Q

Who should ideally perform the preoperative visit?

A

An anaesthetist, preferably the one administering the anaesthesia.

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3
Q

What are the key objectives of the preoperative visit?

A

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

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4
Q

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

A

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

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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

A

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

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9
Q

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

A

To reduce the risk of perioperative re-infarction.

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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

What considerations should be made for diabetic patients undergoing surgery?

A

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

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15
Q

How does chronic renal failure affect anaesthetic management?

A

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

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16
Q

Why is family history important in a preoperative assessment?

A

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

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

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

A

There is an increased risk of regurgitation and aspiration.

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20
Q

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

A

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

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21
Q

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

A

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

22
Q

What should be examined in the respiratory system before surgery?

A

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

23
Q

What is the importance of airway evaluation in preoperative assessments?

A

To predict potential difficulties with intubation and airway management.

24
Q

How can an anaesthetist predict a difficult intubation?

A

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

25
Q

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

A

Wilson’s score, Mallampati criteria, thyromental distance.

26
Q

What are some special investigations needed in preoperative assessment?

A

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

27
Q

When is a medical referral necessary before surgery?

A

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

28
Q

What cardiovascular conditions might necessitate a medical referral?

A

Uncontrolled hypertension, symptomatic ischaemic heart disease, uncontrolled arrhythmias.

29
Q

What respiratory diseases warrant a medical referral before surgery?

A

Severe COPD, unstable asthma, bronchiectasis.

30
Q

What endocrine disorders should be managed carefully before surgery?

A

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

31
Q

What haematological disorders might complicate anaesthesia?

A

Bleeding diatheses, haemoglobinopathies, polycythaemia, leukaemias.

32
Q

What is the ASA Physical Status Classification System?

A

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

33
Q

What are the different surgical risk classifications?

A

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

34
Q

How should patients be informed about their anaesthetic options?

A

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

35
Q

What are the fasting guidelines for patients before surgery?

A

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

36
Q

What are the goals of premedication in anaesthesia?

A

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

37
Q

What factors should be considered before prescribing premedication?

A

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

38
Q

What are the pharmacological components of premedication?

A

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

39
Q

What drugs are commonly used for anxiolysis as premedication?

A

Benzodiazepines, phenothiazines.

40
Q

What medications are used for amnesia in premedication?

A

Lorazepam.

41
Q

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

A

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

42
Q

What is the purpose of administering antacid premedication?

A

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

43
Q

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

A

To manage parasympathetic reflexes and excessive vagal activity.

44
Q

How can premedication facilitate the induction of anaesthesia?

A

By reducing anxiety and providing optimal physiological conditions.

45
Q

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

A

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

46
Q

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

A

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

47
Q

What are some key premedication agents for pain management?

A

NSAIDs, opioids, and local anaesthetics.

48
Q

Why might clonidine or dexmedetomidine be used as premedication?

A

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

49
Q

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

A

To predict and prepare for difficult airway management.

50
Q

How do conditions like micrognathia affect airway management?

A

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

Anaesthesia (16 decks)

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