Pre-op assessment and preparation Flashcards
traumas of surgery
fluid shifts
stress response
CVS, resp, renal and metabolic stress
blood loss
Considerations before surgery
post op care
anaesthetic technique
patient - known and unknown pathologies
nature of surgery
Anaesthetists role pre op
assess identify high risk optimise minimise risk inform and support patients decisions consent
Why do anaesthetists have this role pre op?
reduce anxiety, hospital stays, cancellations, delays, mortality, complications
When do anaesthetists undertake their pre-op role?
elective planned surgery - primary care, pre-assessment clinic
urgent surgery
emergency surgery
History of patient pre-op
known co-morbidities unknown co-morbidities ability to withstand stress drugs and allergies previous surgery and anaesthesia potential anaesthetic problems
investigating patients ability to withstand stress
cardio-respiratory disease
reason for limitation
exercise tolerance
Potential anaesthetic problems examples
airway spine reflux obesity rarities/FH - cholinesterase deficiency, malignant hyperprexia
Reasons for pre-op investigations
detect unknown conditions diagnose suspected conditions severity eg COPD establish baseline detect complications assess risk guiding management
NICE - how to grade patients pre-op
ASA grade, surgery grade and co-morbidities
CVS investigations
Echo - ECG - myocardial perfusion scan - exercise tolerance test - stress echo - cardiac catheterisation - CT coronary angiogram
Resp investigations
saturations - ABG - CXR - CT - peak flow - gas transfer - FVC/FEV
ASA grading
1 = otherwise healthy 2 = mild to moderate systemic disturbance 3 = severe systemic disturbance 4 = life threatening disease 5 = moribund patient 6 = organ retrieval
Cardiac risk index
IHD congestive heart failure high risk surgery CVD diabetes renal disease
Exercise tolerance - METS question
can you do the following without getting breathless?
