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phase 2 - peri-op > Pre-Op Management > Flashcards

Pre-Op Management Flashcards

1
Q

What is an ASA score?

A

A score for how risky a patient is to undergo an operation

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2
Q

What defines ASA 1?

A

Normal, healthy patient

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3
Q

What defines ASA 2?

A

Mild systemic disease

  • One medication
  • Well controlled and only few attacks (Asthma/COPD)

Includes Obesity, Smokers, Drinkers

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4
Q

What defines ASA 3?

A

Severe systemic disease

  • Poor Control
  • Limiting
  • Lots of medications

Dialysis Patients

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5
Q

What defines ASA 4?

A

Someone with life-threatening systemic disease

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6
Q

What defines ASA 5?

A

Not expected to survive but would die otherwise

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7
Q

What defines ASA 6?

A

Brainstem dead patient

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8
Q

What tests do anesthetists do to assess intubation difficulty?

A

Mallampati
Thyromental distance (>3cm)
Neck movement
Jaw opening

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9
Q

What are the levels for mallampati?

A

1 - fully visible tonsils
2- partial
3 - only hard and soft palate
4 - only hard palate

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10
Q

What tests do you give routinely for a major Op to a ASA 1?

A

FBCs

U&Es/eGFR if risk of AKI
(ECG if over 65 and not had within 12 months)

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11
Q

What tests do you give routinely for a major Op to a ASA 2?

A

FBC
Kidney Function
ECG

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12
Q

What tests do you give routinely for a major Op to a ASA 3+?

A 
FBC
U&Es
eGFR
ECG
Haemostasis
Lung Function Test
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13
Q

What other investigations might you offer pre-op?

A

Urine Dip - diabetes, UTI, pregnancy

Echo - if murmur or heart failure

Liver Function

CXR - infection

Glucose

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14
Q

What basic tests would you always do?

A 
Height
Weight
Pulse
Check recent bloods
MRSA swab
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15
Q

What HbA1c do you want for surgery?

A

<7.5 ideally

NEVER more than 8.5

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16
Q

What makes up the haematological assessment?

A

Hx of Bleeding or FHx of disorders

FBC - thrombocytopenic, platelet count, immune function, anaemia (can they carry as much O2? anaemics bleed more and have longer recovery)

Group and Save

Crossmatch

Sickle Cell Testing

17
Q

What allergies are important to ask about?

A

Egg and Soya - propofol

Medications/Antibiotics/Penicillin

Latex

Suxamethonium Apnoea

Malignant Hyperthermia

18
Q

How do you manage Latex allergies around surgery?

A

Have their own room
1st on the list
All latex is taken out the night before
Non-latex gloves are worn

19
Q

Religious?

A

Jehovah’s Witnesses and Blood transfusion

20
Q

Why ask about GORD?

A

As they may need a rapid sequence intubation

Risk of aspiration pneumonia

21
Q

What do you ask someone with asthma?

Why is asthma important to remember?

A

Can they have NSAIDs?

How well controlled?

Higher risk of pneumothorax and bullae formation, bronchospasm

22
Q

Why is renal/liver function important?

A

Drug Excretion
May need to lower the dose
- risk of overdoing it

Contrast may be used

Clotting Factors may be reduced

Hypermetabolism!

23
Q

How do you manage diabetics peri-operatively?

A

1st on list

If they miss one meal then sliding scale insulin in operation

24
Q

Which medications do you stop and when?

A

Clopidogrel - 7 days

Hypoglycaemic Agents on the day of surgery

Oral Contraceptive Pill - 28 days before and cover with alternative (also HRT)

Warfarin - 5 days before (INR needs to be under 1.5)

25
Q

What other drugs do you stop?

A

Herbal Remedies
Hypotensive agents on the day (except beta blockers)
NSAIDs - stop at least 2-3 days before surgery

26
Q

What medications do you NOT stop?

A

Aspirin
Steroids
Thyroxine

27
Q

What is in DVT prophylaxis?

A

TED stockings

LMWH (5000u night before or 2500 on the day)

28
Q

When do you give antibiotics in an operation?

A

Dirty surgery
Risk of perforation/opening an organ
ALWAYS in Obs and Gynae
If inserting a device into the patient

29
Q

When don’t you give TED stockings?

A

In vascular surgery

30
Q

When don’t you give LMWH?

A

Neck surgery

Endocrine surgery

31
Q

When do you stop eating/drinking?

A

Food 6 hours

Clear fluids 2 hours

32
Q

Paeds: When do you stop eating/drinking?

A

Breast milk 4 hours

Formula 4-6 hours

phase 2 - peri-op (5 decks)

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