Pre-Operative Assessment

Question 1

History of presenting complaint

Answer 1

A brief history of why the patient first attended and what procedure they have been scheduled for.

Also confirm the side on which the procedure will take place if that is applicable.

Question 2

PMH

Answer 2

CVD with HTN and exercise tolerance due to the risk of an acute cardiac event during anaesthesia is increased.

Respiratory disease

Renal disease can increase the incidence of surgical complications

Endocrine disease

Also should ask about if they’re pregnant if female.

Check sickle cell disesae

Question 3

What other history to ask about?

Answer 3

Past surgical history

Past anaesthetic history

Drug history

Family history

Social history

Question 4

What is important to ask about in family history?

Answer 4

Malignant hyperpyrexia aka malignant hyperthermia

Question 5

What is malignant hyperpyrexia?

Answer 5

Autosomal dominant condition that leads to muscle rigidity despite neuromuscular blockade.

This follows by a rise in temperature

Question 6

What examinations are done pre-op?

Answer 6

General examination to identify any underlying undiagnosed pathology present

Airway examination to predcit the difficulty of intubation

Question 7

What grade is used pre-op to assess airways?

Answer 7

American Society of Anaesthesiologists Grade (ASA)

Question 8

What guides what investigations should be done?

Answer 8

The ASA grade

Question 9

Investigations usually done

Answer 9

FBC usually done

U&Es this can help with IV fluid management

LFTs for liver metabolism and synthesising function.

Clotting screen if there is indications of deranged coagulation

Group and save +/- cross-matching

Question 10

What is the difference between group and save and cross-match?

Answer 10

G&S = determines patient’s blood group ABO and RhD and screens the blood for any atypical antibodies.
It takes around 40 minutes and no blood is issued

Cross-match involves physically mixing patient’s blood with donor’s blood to see if any immune reaction takes place.
If it doesn’t the donor blood is issued and can be transfused in to the patient.
This takes around 40 minutes as well + the 40 minutes required for the G&S which must be done first.

Question 11

When is G&S done?

Answer 11

If blood loss is not anticipated but blood may be required should there be greater blood loss than expected.

Question 12

When is cross-match done?

Answer 12

If blood loss is anticipated.

Question 13

Imaging that you might do.

Answer 13

ECG

CXR

Question 14

When should ECG or ECHO be done?

Answer 14

ECG if history of CVD or for thos undergoing major surgery.

ECHO - May be condisered if a heart murmur, cardiac symptoms or symptoms of heart failure.

Question 15

Indications for CXR

Answer 15

Respiratory illness who have not had a CXR within 12 months

New cardiorespiratory symtpoms

Recent travel where TB is endemic

Significant smoking history

Question 16

Other tests you might do

Answer 16

Pregnancy test

Sickle cell test

Urinalysis

MRSA swabs

Question 17

Explain the airway examination

Answer 17

Ask patient to open their mouth.

Assess their degree of mouth opening (Inter-incisor distance >3cm is favourable)

Assess their teeth, do they have them? denititions? teeth loose?

Their oropharynx and ask patient to maximally protrude their tongue.

Mallampati classification which correlates with difficulty to intubate can be assessed.

ASsess neck, flexion, extension, laterally flex etc…

Ask them to maximally extend their neck and measure the distance between thyroid cartilage and the chin.
If this is less than 6.5 cm (3 fingers) it indicates that intubation may be difficult