Pre-operative assessment and preparation

Question 1

Trauma of surgery ? (4)

Answer 1

• Stress response
• Fluid shifts
• Blood loss
• Cardiovascular, respiratory, renal and metabolic stress

Question 2

what does a general anaesthetic do?

Answer 2

suppress your neurological, cardiac and respiratory system

Question 3

considerations for anaesthesia? (5)

Answer 3

• Known co-morbidities
• Unknown pathologies
• Nature of surgery
• Anaesthetic techniques
• Post-op care

Question 4

Anaesthetist role pre-op (6)

Answer 4

Assess
Identify high risk 
Optimise (co-morbidities)
Minimise risk 
Inform and support patients decisions
Consent

Question 5

when won’t you give a spinal anaesthetic to someone?

Answer 5

those with aortic stenosis

- suppress cardiac function

Question 6

features that fall under the ‘ ability to withstand stress’

Answer 6

• Exercise tolerance
• Reason for limitation
• Cardio-respiratory disease

Question 7

Features you want to find out in history? (2)

give some specific anaesthetic problems?

Answer 7

Drugs and allergies
Previous surgery and anaesthesia

Potential anaesthetic problems 
Airway 
Spine 
Reflux
Obesity 
Rarities / Family history
Malignant hyperpyrexia
Cholinesterase deficiency

Question 8

Rarities / Family history - some conditions to look out for?

Answer 8

Malignant hyperpyrexia

Cholinesterase deficiency

Question 9

NICE guidelines for investigations (3)

Answer 9

ASA grade
Surgery grade
Co-morbidities

Question 10

ASA grading is used to?

scores up to?

Answer 10

identify how fit and healthy a patient is/how sick they are

ASA6

Question 11

ASA4 means?

Answer 11

life threatening disease

Question 12

ASA3 means?

Answer 12

Severe systemic disturbance

Question 13

ASA5 means?

Answer 13

Moribund patient

Question 14

ASA6 means?

Answer 14

organ retrieval

Question 15

ASA2 means?

Answer 15

Mild to moderate systemic disturbance

Question 16

ASA1 means?

Answer 16

Otherwise healthy patient

Question 17

Cardiac risk index - what you will be vary of in patients?

Answer 17

• High risk surgery
• Ischaemic heart disease
• Congestive heart failure
• Cerebrovascular disease
• Diabetes
• Renal failure

Question 18

Exercise tolerance - METs

- Can you do the following activities without getting breathless?

Answer 18

Walk around the house 2 METS

Do light housework 3 METS

Walk 100-200 metres on the flat
4 METS

Climb a flight of stairs or walk up a hill
5 METS

Walk on the flat at a brisk pace
6 METS

golf, dance, walk
7 METS

Run a short distance 8 METS

Do either strenuous exercise or heavy physical work 9 METS

Question 19

Optimising? REDUCES RISKS FOR WHAT CONDITIONS

Answer 19

• Hypertension
• Ischaemic heart disease
• Heart failure
• Asthma
• COPD
• Diabetes
• Epilepsy

Question 20

Smokers have a higher risk of? (3)

Answer 20

• respiratory conditions
• chest infections post operatively
• poor would healing

Question 21

Alcoholics - have a high risk of?

Answer 21

infection and septic shock

- helps reduces complications

Question 22

what can you offer pre-surgery?

Answer 22

Pre-habilitation

• Improved fitness = improved outcomes
• reduced mortality risk

Question 23

High risk emergency patient ? (5)

Answer 23

• Informed consent
• Anaesthetic plan
• Invasive monitoring
• Senior management
• Post operative critical care

Question 24

pre-op medication? what needs to be 100% continued? (3)

Answer 24

Inhalers
Anti-anginals
Anti-epileptics

Question 25

Possible exceptions for pre-op medication? (2)

Answer 25

Anti-diabetic medication | Anticoagulants