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Peri-Operative Care [16] > Pre-Operative Assessment > Flashcards

Pre-Operative Assessment Flashcards

1
Q

What is the purpose of the pre-operative assessment?

A

Opportunity to identify comorbidities that may lead to patient complications during anaesthetic, surgical, or post-operative period

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2
Q

When should pre-op assessment for elective procedures take place?

A

Ideally 2-4 weeks before date of surgery

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3
Q

What should a pre-operative history contain?

A
  • History of presenting complaint
  • PMH
  • Past surgical history
  • Past anaesthetic history
  • Drug history
  • Family history
  • Social history
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4
Q

What should be included in the history of presenting complaint in pre-operative assessment?

A

Brief history of why the patient first attended, and what procedure they have been scheduled for. Confirm on which side the procedure should be performed

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5
Q

What should be included in the PMH in pre-operative assessment?

A

Full PMH, asking specifically about;

  • Cardiovascular disease
  • Respiratory disease
  • Renal disease
  • Endocrine disease
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6
Q

What specifically should be asked about regarding cardiac disease in pre-op assessment?

A
  • Exercise tolerance

- Hypertension

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7
Q

Why is it important to ask about cardiac disease in pre-op assessment?

A

Risk of acute cardiac event is increased during anaesthesia

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8
Q

Why is it important to ask about respiratory disease in pre-op assessment?

A

Adequate planned oxygenation is essential in reducing risk of acute ischaemic events in peri-operative period

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9
Q

Why is it important to ask about renal disease in pre-op assessment?

A

Many features of renal disease, e.g. anaemia, coagulopathy, biochemical disturbances, can increase the risko f surgical complications

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10
Q

What can cause serious renal impairment during surgery?

A
  • Blood loss

- Use of IV contrast

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11
Q

What endocrine diseases should be specifically asked about in pre-op assessment?

A
  • Diabetes mellitus

- Thyroid disease

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12
Q

Why is important to ask about endocrine disease in pre-op assessment?

A

Many medications often required specific changes to made in peri-op period

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13
Q

What should be asked about past surgical history in pre-op assessment?

A

Have they had any previous operations - if so, what, when, and why?

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14
Q

What should be asked about past anaesthetic history in pre-op assessment?

A

Have they had any anaesthesia before? If so, were there any issues? Did they have any post-op N&V?

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15
Q

What should be asked about drug history in pre-op assessment?

A
  • Full drug history

- Drug allergies

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16
Q

Why is it important to obtain a full drug history in pre-op assessment?

A

Some medications require stopping or altering prior to surgery

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17
Q

What is it important to ask about in family history in pre-op assessment?

A
  • Malignant hyperthermia

- Any other adverse reactions to surgery in immediate family members

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18
Q

What is malignant hyperthermia?

A

An autosomal dominant condition that characteristically leads initially to muscle rigidity followed by rise in temperature

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19
Q

What should be asked about social history in pre-op assessment?

A
  • Smoking history
  • Alcohol intake
  • Exercise tolerance
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20
Q

What examinations are performed in pre-op examinations?

A
  • General examination

- Airway examination

21
Q

What does the investigations undertaken before surgery depend on?

A

Number of factors, including co-morbidities, age, and seriousness of procedure

22
Q

I think I’ve already done this somewhere else so leave it for now

A

ok

23
Q

What medications should be stopped/changed in surgery?

A
  • Warfarin
  • Oral anticoagulants
  • Clopidogrel and aspirin
  • COCP/HRT
  • Insulin
  • Oral hypoglycaemics
  • Steroids
  • ACEi’s
  • ARB’s
24
Q

When should warfarin be stopped prior to surgery?

A

5 days

25
Q

What should be given whilst warfarin is stopped?

A

LMWH

26
Q

What is the target INR prior to surgery?

A

1.5

27
Q

When can warfarin be resumed after surgery?

A

12-24 hours if haemodynamicly stable

28
Q

When should DOACs be stopped prior to surgery?

A

48 hours

29
Q

When should aspirin be not stopped prior to surgery?

A

In patient’s with recent ACS, coronary stents or stroke

30
Q

When should COCP and HRT be stopped prior to surgery?

A

4-6 weeks

31
Q

Why must COCP and HRT be stopped prior to surgery?

A

Increased risk of VTE

32
Q

What should happen to patients on insulin therapy prior to surgery?

A

Avoid morning dose and convert to VRII from midnight

33
Q

What should continue to be given alongside a VRII?

A

Long acting insulin at 80% normal dose

34
Q

Where should diabetics be on the surgical list?

A

First in the morning

35
Q

When should oral hypoglycaemics be stopped?

A

On the day of surgery

36
Q

When can diabetics resume normal treatment regime?

A

When eating and drinking

37
Q

What should happen to steroids in surgical patients?

A

Be continued and convert to IV hydrocortisone if needed

38
Q

What group of patients are at risk of Addisonian crisis?

A

Those on >5mg/day

39
Q

What may patients on steroids need?

A

An increased dose to ensure appropriate metabolic response to surgical stress

40
Q

When should ACEi’s be omitted?

A

On the morning of surgery

41
Q

What medications should be continued?

A
  • Thyroid medications
  • Anticonvulsants
  • Betablockers
42
Q

What forms the general pre-op examination?

A
  • CVS
  • Resp
  • Abdo
  • Operation relevant
43
Q

What forms the anaesthetic examination?

A
  • Look for facial abnormalities
  • Assess mouth opening
  • Inspect teeth
  • Oropharynx (Mallampati)
  • Neck ROM
  • Thyromental distance
44
Q

What facial abnormality is particularly problematic for intubation?

A

Retrognathia

45
Q

How is the oropharynx assessed for ease of intubation?

A

Mallampati score

46
Q

Why should dentition be assessed prior to anaesthesia?

A

To look for lose, damaged or false teeth

47
Q

What Neck movements should be assessed prior to surgery?

A
  • Lateral flexion
  • Extension
  • Flexion
48
Q

How should thyromental distance be assessed?

A

Ask patient to extend neck and see if three finger breadths can fit between chin and thyroid cartilage

Peri-Operative Care [16] (20 decks)

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