Pre-operative Assessment

Question 1

Anaesthesia considerations?

Answer 1

Patient:
Documentation
Physical examination (general, airway, respiratory, CVS, other)
Psychological status

Procedure:
Type/technique of surgery
Elective, urgent or emergent
Surgeon’s preference

Question 2

Important questions to ask in the history?

Answer 2

Baseline level of functioning
Current symptoms of note
Co-morbid illnesses
Family history
Allergies/drug intolerances
Previous anaesthesia exposure and complications
Smoking history
Alcohol history
Drug history
Nil per Os (NPO) status

Question 3

Examples of pre-operative optimisation?

Answer 3

Fluid balance
Electrolyte disroders
Anaemia
Infections
Bornchospasms (asthma/COPD)
Cardiac failure
Diabetes
Smoking

Question 4

Timelines for pre-operative optimisation?

Answer 4

Elective: pre-determined booked time, thus no urgency
Urgent: must be done within 24 hours
Emergent: must be done within the hour

In emergency surgery, a balance between urgency of surgery and patient safety should be sought to allow maximal pre-operative optimisation

Question 5

Things to consider in patient documentation?

Answer 5

Patient information: name, age, folder number, height, weight, BMI
Diagnosis
Surgical procedure to be done
Laterality (L or R)
Intra-operative positioning
Patient consent

Question 6

How should patient consent by attained?

Answer 6

Before pre-medication given
In writing
Informed and voluntary
Patient must be legally competent
Form must be signed by a doctor and witnesses by two other people

Question 7

Examination and special investigation?

Answer 7

General
Airway: face, mouth. neck, trachea
Respiratory: clinical exam, CXR, ABG, PFT
CVS: clinical exam, HR, BP, JVP, hydration status, CXR, ECG, serum chemistry (K+), Hb, echo
Renal and hepatic function
Neurological function
Musculo-skeletal

Question 8

Psychological pre-operative preparation?

Answer 8

Patient anxieties should be allayed
Be calm, practical and reassuring
Good pre-medication

Question 9

Premedication: indications and treatment?

Answer 9

Anxiety: benzodiazepine
Sedation: benxodiazepine, opiates
Analgesia: paracetamol, opiates
Anti-emesis
Anti-sialogogue: anti-cholinergics
Protection from acid aspiration: sodium citrate, H2 receptor antagonist, PPI
Protection from cardiac ischaemia: B-blockers, nitrates, statins
Protection from hypertension: B-blockers
Protection from bronchospasm: B-agonist
Protection from DVT’s: heparin, TED stockings, calf-compression devices

Question 10

ASA grading?

Answer 10

American Society of Anaesthesiologists

I: normal healthy patient
II: mild systemic disease
III: severe systemic disease
IV: severe systemic disease that is a constant threat to life
V: moribund patient who is not expected to survive with or without the operation
VI: declared brain-dead whose organs are being removed to transplant