Pre-Operative Assessment

Question 1

Structure of pre-op assessment? KO

Answer 1

History of PC
PMH
PSH
PAH
DH + Allergies
FH
SH

Question 2

What is important to ask about in the PMH?

Answer 2

CVS disease - hypertension and exercise tolerance
- Risk of acute cardiac event increased during anaesthesia
Respiratory disease
- Adequate oxygenation to reduce risk of acute ischaemic events
Renal disease
- Anaemia, coagulopathy, electrolyte disturbance can increase complications
Endocrine disease
- DM, thyroid - changes to medication
Female of reproductive age - Pregnancy?
African-American - Sick cell disease?

Question 3

What is it important to ask females?African Americans?

Answer 3

Pregnancy

Sickle cell disease

Question 4

What is it important to ask about in past anaesthetic history?

Answer 4

Post-op nausea and vomiting

Question 5

What is it important to ask about in the family history?

Answer 5

Malignant hyperthermia - autosomal dominant condition that leads to muscle rigidity (despite neuromuscular blockage) followed by a risk in temperature

Question 6

What is important to ask about in the SHx

Answer 6

Smoking, alcohol, exercise tolerance

Question 7

What examinations are performed pre-operatively?

Answer 7

General examination for underlying pathology

Airway examination to predict difficulty of intubation

Question 8

What pre-operative investigations would you carry out?

Answer 8

FBC - undiagnosed anaemia or thrombocytopenia requiring correction
U&E - baseline renal function for any IV fluid management
LFT - liver metabolism and synthesising function
Clotting screen - derange coagulation (e.g. warfarin, inherited coagulopathy, liver or renal impairment)
Group and Save/Cross Match

ECG

Question 9

What is a group and save?

Answer 9

Determines the patient’s blood group (ABO and RhD) and screens the blood for any atypical antibodies.
The process takes around 40 minutes and no blood is issued.
A G&S is recommended if blood loss is not anticipated, but blood may be required should there be greater blood loss than expected.

Question 10

What is a cross match?

Answer 10

Physically mixing the patient’s blood with the donor’s blood in order to see if any immune reaction takes place.
If it does not, the donor blood can be issued and transfused into the patient, otherwise alternative blood is trialled. This takes around 40 minutes in addition to the 40 minutes for the G&S done first.
Cross match is don if blood loss is anticipated.

Question 11

When is a CXR indicated?

Answer 11

Respiratory illness who have not had XR in 12 months
New Cadioresp signs
Recent travel from endemic TB
Significant Smoking Hx

Question 12

What other tests should be performed?

Answer 12

Pregnancy
Sickle cell if indicated
MRSA swab from nostril, perineum and other sites
Urinalysis if suspicion of glycosuria or UTI (not routine)