Pre-op Goals Flashcards
What are the goals of the preoperative evaluation?
• Gathering necessary information about the patient and formulating an appropriate anesthetic plan.
• To make sure the patient is medically optimized to limit perioperative risks.
What should happen during the pre-anaesthesia evaluation?
• Review of medical record and determination of (ASA) status
• Physical examination, which at a minimum includes an evaluation of the airway, heart, and lungs.
• Discuss medical conditions, allergies, previous anesthetics, family history of problems with anesthesia,
and nothing by mouth (NPO) status.
• Review available pertinent medical records and order additional tests and consults if necessary.
Why is it important to ask about previous anesthetic complications?
- A patient’s previous anesthetic experience may provide valuable information, which could change anesthetic management.
• Patients who have had a family history of malignant hyperthermia or fevers under anesthesia should receive a nontriggering anesthetic.
• Patients with history of PONV may benefit from preoperative medications, regional anesthesia and/or a TIVA technique.
• Patients with known difficult airways are often informed of this after receiving prior anesthetics and may recall the need to tell future clinicians when prompted.
Describe the ASA physical status classification.
It is a grading system is a 1 to 6 grading system quantitating a patient’s physical status immediately before a procedure. It is does not predict operative risk.
• ASA I:
A normal healthy patient (e.g., a healthy, nonsmoker).
• ASA II:
A patient with mild systemic disease (e.g., controlled hypertension, smoker, obesity, etc.)
• ASA III:
A patient with severe systemic disease (e.g., compensated congested heart failure [CHF], COPD, morbid obesity).
• ASA IV:
A patient with severe systemic disease that is a constant threat to life (e.g., uncompensated CHF or COPD).
• ASA V:
A moribund patient who is not expected to survive without the operation (e.g., severe head injury, massive trauma).
• ASA VI:
A declared brain-dead patient whose organs are being removed for donor purposes
The addition of “E” denotes an Emergency surgery. An emergency is defined as existing when any delay in
treatment would significantly increase the threat of death and/or loss of body part.
Describe the ASA I classification.
A normal healthy patient without without organic, biochemical, or psychiatric disease
Adult
• Healthy
• Non-smoking
• No or minimal alcohol use
Paediatrics
• Healthy children with no acute or chronic disease.
• Normal BMI per age percentile
Pregnancy
• None
Describe the ASA II classification.
A patient with mild systemic disease without functional limitations.
Although pregnancy is not a disease, a pregnant patient’s physiological state is significantly altered from the nonpregnant state.
Adult
Paediatrics
Obstetric
Describe the ASA III classification.
A patient with severe systemic disease with substantial functional limitations.
Adults
Paediatrics
Obstetric
Describe the ASA IV classification.
A patient with severe systemic disease that is a constant threat to life.
Adult
Paediatrics
Obstetric
Describe the ASA V classification.
A moribund patient who is not expected to survive without the operation.
Adult
Paediatric
Obstetric
Describe the ASA VI classification.
A brain-dead patient whose organs are being removed for donor purposes.
What are the preoperative fasting guidelines?
• Clear liquids—2 hours
• Breast milk—4 hours
• Infant formula, nonhuman milk, nonclear liquids—6 hours
• Light meal—6 hours.
• Full meal, fried or fat-rich foods—8 hours.
• Chewing gum — 2h. If swallowed 6h.
• Alcohol — 6h delays gastric emptying and decreases small intestine motility.
What is the exception of the NPO guidelines?
• Emergency cases: should proceed regardless of NPO status.
• Urgent cases: a discussion regarding the risk of waiting versus the risk of proceeding to surgery with a full stomach should occur.
When should coagulation studies be obtained preoperatively?
should be considered for patients with:
• History of a bleeding diathesis;
• Liver or kidney dysfunction;
• Those who are on anticoagulant medications.
During your pre-operative evaluation a patient is discovered to be pregnant / states that she’s pregnant.
What is the safest period to proceed with an elective procedure?
The second trimester (13-27 weeks) is regarded as the safest time for procedures because organogenesis has occurred and the risk of spontaneous abortion or preterm labor is lower.
During your pre-operative evaluation, when should you ask for an ECG?
Patients undergoing moderate-high risk surgery with:
• >= 65 years
• History of heart failure
• MI
• Coronary artery disease
• Valvular disease
• Arrhythmia
• Peripheral arterial disease
• Cerebrovascular disease
• Undergoing vascular surgeries.
