Pre-operative assessment

Question 1

overall structure

Answer 1

previous anaesthetic hx
airway
breathing
circulation
GI
endocrine
exercise tolerance
PMH
DH
SH
FH

Question 2

previous anaesthetic hx

Answer 2

• Previous anaes. + type
• Type of operation and when
• Difficulty intubating, PONV, post op pain,
• FHx of malignant hyperthermia, Suxamethonium apnoea

Question 3

airway

Answer 3

• Snoring/ obstructive sleep apnoea
• MSK: Arthritis limiting neck movements
• Dental History: loose teeth, caps, crowns, dentures

Question 4

breathing

Answer 4

• Asthma, COPD, Recurrent infections, Restrictive lung disease
• SOB – at rest or on exertion
• Paroxysmal nocturnal dyspnoea
• Asthma
  o Triggers
  o How often is the patient needing to use SABA (>3x week is a concern)
  o Previous admissions for exacerbation of asthma (ITU or ward based)

Question 5

circulation

Answer 5

• MI, Angina (stable or unstable), PVD

Question 6

GI

Answer 6

• Sensitively asks about weight
• Heart burn, REFLUX, acid brash, GORD
• Hiatus hernia

Question 7

endocrine

Answer 7

• Diabetes, thyroid problems, Addison’s disease

Question 8

exercise tolerance

Answer 8

• How far can they walk on the flat
• Can they climb a flight of stairs/ run for a bus
• Independent of ADLs?

Question 9

PMH

Answer 9

others
pregnancy?

Question 10

DHx

Answer 10

• anticoagulants, antihypertensives, time critical
• Drug allergies
• Explicitly ask female about COCP
• Over the counter medications
• Recreational drugs

Question 11

SHx

Answer 11

• Type of house, how many storeys
• Who lives with patient at home
• Will there be anyone to look after the patient upon patient discharge
• Independent of ADLs
• Alcohol
• Smoking

Question 12

FHx

Answer 12

• Inherited conditions which run in the family, e.g. blood disorders
• Any family members had problems with operations/GA?
• Any sudden unexplained deaths in the family? Malignant hyperpyrexia

Question 13

2 things left to do

Answer 13

prior investigations
meds to stop

Question 14

prior investigations

Answer 14

• musnt’s over investigate
• disease specific: coagulation in liver disease (INR/PT/albumin) // sickle cell if fam hx
• FBC, U&Es, 12-lead ECG, CRP, LFTs,, G&S (2 samples)
• lung function - PEFR

Question 15

meds essential to continue

Answer 15

• Anti-epileptics
• PD
• Steroids (may need to +++ dose)

Question 16

anticoagulants to stop

Answer 16

• Aspirin - continue
• Clopidogrel - stop 7 days prior
• Warfarin - 5 days prior (bridge with LMWH if needed)
• DOACs - 24-72 hours prior (depends on renal function)
• LMWH - 12 hours prior

Question 17

diabetes meds changes

Answer 17

• ALWAYS continue long-acting insulin
• 80% dose day before & during reduced meal intake
• If missing >1 meal —> VRII
• omit hypo meds (sulphonylurea, SGLT-2i)

Question 18

VTE prophylaxis

Answer 18

• At least 4 hours after surgery
  
  • 6pm if AM
  • 10pm if PM
• longer duration if cancer

Question 19

fasting rules

Answer 19

• 2 hours - clear fluids (not fizzy with sediment)
• 4 hours - breastmilk
• 6 hours - solid food
• Tablets - take with a small sip of water (preferably <30ml) at any time
• Paediatrics - fluids up to 1 hour

Question 20

general examination

Answer 20

• General appearance
• Brief cardiovascular/respiratory
• Airway/dental
• Obs
  
  • HR, BP, RR, SpO2, temp, cap glucose
  • Weight & height
• Hydration status assessment

Question 21

airway assessment

Answer 21

• malampati
• mouth opening // jaw in front of mouth
• dental
• neck movement