Pre-Operative Assessment Flashcards
What examinations are performed prior to surgery
- General examination to determine health of patient
- Airway exam be anaesthetists
What grading system is used to determine someones risk with intubation
ASA (American society of anesthesiologists)
what is ASA I
Healthy Patient
what is ASA 2
Mild Systemic Disease
what is ASA 3
Severe Systemic Disease
what is ASA 4
Severe Systemic Disease that is a constant threat to life
what is ASA 5
Would not survive without the operation
what is ASA E
Emergency Procedure
give examples of a minor surgery
Skin lesion excision
Incision and drainage or abscess
what two investigations may be ordered in minor surgery
ECG
U+E
when is U+Es required for minor surgery
Risk of AKI
when is ECG required for minor surgery
Not had an ECG in past 12-months
Give examples of intermediate surgery
- Inguinal hernia repair
- Tonsillectomy
- Excision varicose veins
- Knee arthroscopy
What investigations may be ordered for ASA 2 in intermediate surgery
ECG
U+E
When are U+Es ordered for intermediate surgery
CKD, Risk AKI
When is an ECG ordered in intermediate surgery
CVD
What tests may be ordered for ASA 3 or 4 in intermediate surgery
- FBC
- Coagulation studies
- ABG and Lung Function Tests
- U+E. always
- ECG = always
When is FBC ordered
ASA 3/4 and CVD or Renal Disease
When are coagulation studies ordered
ASA 3/4 and chronic liver disease or taking anti-coagulants
When are ABG or LFTs ordered
ASA 3/4 and rest disease
What counts as a major surgery
TURP
Hysterectomy
Thyroidectomy
Joint replacement
what is ordered if blood loss is expected in the surgery
Group and Save, Cross-Match
what tests are ordered in all female patients prior to surgery
Pregnancy Test
when is a sickle cell test ordered pre-operatively
Afro-Carribean Patients with a History of Sickle Cell
when are MRSA swabs ordered
All patients
how long should patients stop eating prior to surgery
6 hours
how long should patients stop the intake of clear fluids
2 hours
what is a mnemonic to remember drugs to stop prior to surgery
CHOW
what drugs should be stopped prior to surgery
Clopidogrel
Hypoglycaemic
Oral contraceptive
Warfarin
how long before surgery is clopidogrel stopped
7-days
how long is COCP and HRT stopped prior to surgery
4 Weeks
why is COCP stopped prior to surgery
Due to increased VTE risk
how long is warfarin stopped prior to surgery
5-days
if warfarin is stopped what is it bridged with
LMWH
how long prior to surgery is LMWH stopped
24h
what INR is required for surgery to proceed
< 1.5
what should SC insulin regimens be changed to prior to surgery
Variable rate infusion insulin
if a patient is on long-term steroids, should these be stopped and why
Continue steroids as otherwise on stopping can cause addisonian crisis
what should all patients have prior to surgery
VTE Risk assessment
how long following surgery are individuals given LMWH for
28 days
what are individuals given in addition to LMWH
TED Stockings
in addition to VTE, what else may be prescribed in surgery
Antibiotic prophylaxis
how long should patients be advised to stop smoking prior to the operation
2 months
explain corticosteroids during surgery
Continue corticosteroids - as stopping corticosteroids can risk addisonian crisis
in diabetic patients what should be measured prior to surgery
HbA1C
in what HbA1c should the surgery be delayed
> 69
where should diabetic patients be put on the surgery list
First patients - as they are kept NBM overnight
in T1DM, what is done the night before surgery
Given 1/3 of their SC dose of insulin
in T1DM, what should be done the morning of surgery
SC insulin is switched to IV variable infusion rate insulin
what is a sliding scale of insulin
50 Units actarapid in 49.5 ml Saline
how much dextrose should be given if NBM
5% Dextrose at a rate of 125ml/h
how often are BM’s checked
Every 2-hours
