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Anaesthesiology > PreOp Assessment > Flashcards

PreOp Assessment Flashcards

1
Q

What are the 3 steps to pre op assessment

A

History
Examination
Investigation

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2
Q

List 6 important components of the preop hx

A
  • age and gender
  • indication for surgery
  • surgical/anesthetic surgery
  • familial hx
  • medications & allergies
  • past medical hx
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3
Q

What aspect of the past surgical/Anesthetic hx is important?

A
  • past intubation
  • PONV
  • anaesthesia complications
  • previous anaesthetics
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4
Q

What details are important in the family hx

A
  • anaesthetic reactions
  • MH (malignant hyperthermia)
  • pseudocholinesterase deficiency
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5
Q

It is good to ask system based medical histories. What are you looking for in your Neuro hx?

A

TIA/Strokes
Raised ICP
Spinal Disease
Aneurysm
NMJ problems

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6
Q

It is good to ask system based medical histories. What are you looking for in your CVS hx?

A

angina/cad
MI
CHF
HTN
Valvular disease
Dysrythmias
PVD

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7
Q

It is good to ask system based medical histories. What are you looking for in your Respi hx?

A

Smoking
Asthma
COPD
URTI
apnea

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8
Q

It is good to ask system based medical histories. What are you looking for in your GI hx?

A

GERD
Liver disease
NPO status

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9
Q

It is good to ask system based medical histories. What are you looking for in your Renal hx?

A

Chronic Renal Failure
Dialysis

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10
Q

It is good to ask system based medical histories. What are you looking for in your MSK hx?

A

Arthralgia
Cervical spinal pathology
Cervical spine instability

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11
Q

It is good to ask system based medical histories. What are you looking for in your Endocrine hx?

A

DM
Thyroid disorders
Adrenal Disorders

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12
Q

It is good to ask system based medical histories. List some other important information not mentioned in the previous systems?

A

Pregnancy
Ethanol/ recreational drug use
Morbid obesity

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13
Q

List 8 aspects of the physical exam for pre op anaes

A
  • weight, height, BP, HR, RR, O2 sat
  • CNS, CVS, RESPI
  • assess nutrition, hydration, mental status
  • Airway assessment & Ventilation
  • Tongue size
  • Dentition, Dental appliances/ prosthetic caps, chipped/teeth
  • Nasal passage latency
  • examination of anatomical sites relevant to lines and blocks
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14
Q

How do you evaluate a difficult airway?

A

L - look (obesity, facial/dental Abn. beard, neck)
E - evaluate 3,3,2 rule
M- Mallampati score
O- Obstruction
N- Neck mobility

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15
Q

How do you assess difficult ventilation anesthesia ?

A

BONES
B- beard
O- obesity
N- no teeth
E- elderly (>55)
S- Snoring hx (sleep apnea)

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16
Q

What is the 3-3-2 rule?

A

1) 3 of the patients own finger can be placed between incisors
2) 3 fingers along the floor of the mandible (between mentum and hyoid)
3) 2 fingers in the superior laryngeal notch (thyroid- mouth distance)

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17
Q

Full view of uvula (body and base of uvula) and Tonsillar pillars describes what Mallampati Score?

A

1

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18
Q

View of the body and base of the uvula, with partial view of the tonsillar pillars describes what Mallampati score

A

II

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19
Q

View of the base of the uvula is described as what Mallampati score

A

III

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20
Q

View of the hard palate with no other visible structures is described as what Mallampati score

A

IV

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21
Q

What grading system is used for Laryngeal View?

A

Cormack- Lehane Classification

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22
Q

Describe Grade 1 Cormack- Lehane Classification

A

All Laryngeal structures revealed

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23
Q

Describe Grade 2A Cormack- Lehane

A

Partial view of the glottis

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24
Q

Describe Grade 2B Cormack- Lehane

A

Only the arytenoids visible

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25
Q

Describe Grade 3 Cormack- Lehane

A

Larynx is concealed only epiglottis seen

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26
Q

Describe Grade 4 Cormack- Lehane

A

Neither epiglottis nor glottis seen

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27
Q

What are three other scoring systems used to assess difficult airways

A

Thyromental distance
Calder test
Wilson Score

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28
Q

List 5 factors of the Wilson Score System

A

(Wilson Understands Joy Ride Baking)
Weight
Upper cervical spine mobility
Jaw movement
Receding mandible
Buck teeth

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29
Q

Describe the ASA classification system

perioperative clinicians a simple categorization of a patient’s physiological status that can help predict operative risk.

A

I A normal healthy patient
II A patient with mild systemic disease
III A patient with severe systemic disease
IV A patient with severe systemic disease that is a constant threat to life
V A moribund patient who is not expected to survive sans surgical procedure
VI A declared brain dead patient whose organs are being removed for donor purposes

The addition of E indicates emergency surgery

30
Q

Which patient counts as a high risk patient

A

Those who must be seen by an anesthesiologist in their pre operative clinic

31
Q

Which patients are usually seen by anaesthesthetists in clinic

A

Patients at or above ASA 3
Prior or anticipated difficulties with anaesthesia
Patients having complex procedures performed

32
Q

What is the target BP reading that you should aim for when dealing with hypertensive patients in anesthesia

A

<180mmHg SBP and <110mmHg DBP

33
Q

Which antihypertensives should be avoided on the day of surgery and why

A

Ace inhibitors and ARBs
Due to the increased risk of refractory hypotension

34
Q

How long should a post MI patient wait before surgery

A

60 days

35
Q

What is the glycaemic target in critical patients with DM

A

<10 mmol/L

36
Q

What is the glycaemic target in stable patients with DM

A

<7.8 mmol/L

37
Q

True or False
Oral anti diabetic medications should be given on the day of surgery

A

False

38
Q

Why are URTI and poorly controlled asthma absolute contraindications for Anaesthesia

A

It can increase the risk of bronchospasm

39
Q

What is the minimum time that you can have a heavy meal before surgery?

A

8hrs

40
Q

What is the minimum time that you can have a light meal/ cow’s milk/ infant formula before surgery?

A

6hrs

41
Q

What is the minimum time that you can have breast milk before surgery?

A

4hrs

42
Q

What is the minimum time that you can have non-alcoholic clear fluids before surgery?

A

2hrs

43
Q

What are the benefits of allowing clear liquids up to 2hours pre-op?

A

Less patient thirst and hunger
Lower risk of aspiration

44
Q

Define premedication

A

The administration of medication before a treatment or procedure

45
Q

What are the 6 A’s of premedication?

A

Anxiolysis
Amnesia
Antiemetic
Antacid
Anti- autonomic
Analgesia

46
Q

Which drug class is administered for anxiolysis and when?

A

Benzodiazepines
(45-90mins before)

47
Q

Which drug class is administered to induce amnesia?

A

Benzodiazepines

48
Q

What is the Moa of benzodiazepines

A

Benzodiazepines facilitate the binding of inhibitory neurotransmitter GABA at various GABA receptors in the CNS

GABA functions to reduce neuronal excitability by inhibiting nerve transmission

49
Q

Benzodiazepines can be classified as long acting, intermediate acting and short acting

List an example of each

A

LA: Diazepam (Valium) 1-3 days
SA: Midazolam (Versed) 3-8 hrs
IA: Alprazolam (Xanax)/ Lorazepam (Ativan) 11-20hrs

50
Q

Which drug classes can be administered as antiemetics ?

A

5-HT antagonist
Dopamine Antagonist
Antihistaminic
Anticholinergic

51
Q

Describe the moa of 5-HT antagonists (selective serotonin antagonists) as antiemetics

A

Vomiting is controlled by the vomiting center in the brain, which is activated by triggers such as strong smell, thoughts and motion.
The cells that line the gastrointestinal tract release serotonin (a chemical messenger responsible for transmitting vomiting signals) when they are damaged.
This serotonin binds to the serotonin receptors present on the nerves that transmit impulses to the vomiting center located in the brain, which in turn activates the vomit reflex.
Antiemetic 5-HT3 antagonists block the serotonin both peripherally, on gastrointestinal vagal nerve terminals, and centrally in the chemoreceptor trigger zone; this blockade results in powerful antiemetic effects.

52
Q

How do Antihistaminic agents function as antiemetics?

A

Histamine is a key molecule for transmitting stimuli from the inner ear to the brain during vomiting due to motion sickness

They block H1 receptors

53
Q

What neurotransmitters are involved in vomiting?

A

acetylcholine,
dopamine,
histamine (H1 receptor),
serotonin (5-HT3 receptor)

54
Q

List 1 Dopamine antagonist

A

Metoclopromide (Reglan)

55
Q

List 1 selective serotonin antagonist

A

Ondansetron

56
Q

List 1 Antihistaminic drug

A

Diphenhydramine (Benadryl)

57
Q

List 3 antacid drug classes used

A

H2 Blocker
PPI
Sodium citrate

58
Q

Describe the moa of H2 blockers

A

H2RAs decrease gastric acid secretion by reversibly binding to histamine H2 receptors located on gastric parietal cells, thereby inhibiting the binding and activity of the endogenous ligand histamine.

59
Q

Give one example of an h2 blocker

A

RANITIDINE
Famotidine

60
Q

Describe the moa of PPI

A

Ultimately, PPIs function to decrease acid secretion in the stomach. The proximal small bowel absorbs these drugs, and once in circulation, affect the parietal cells of the stomach. The parietal cells contain the H+/K+ ATPase enzyme, the proton pump, that PPIs block. This enzyme serves as the final step of acid secretion into the stomach

61
Q

List some PPIs

A

Omeprazole
Esomeprazole
Pantaprazole

62
Q

How does sodium citrate act as an antacid

A

It acts by neutralizing acid in the stomach and urine, raising the pH

63
Q

List two groups of Antiautonomic drugs

A

Anticholinergics
Beta Blockers

64
Q

List 2 groups of Anticholinergic drugs

A

Antisialogogue
Antivagolytic

65
Q

List some Anticholinergic d’agents

A

Atropine IV/IM/SC
Glycopyrrolate - 4mcg/kg IM

66
Q

List some Analgesics

A

Opioids
- Morphine
- fentanyl

67
Q

List 5 contraindications to anaesthesia

A

No consent
Allergy Hypersensitivity
Respiratory Depression
Cardiovascular Issue
Liver or Kidney Dysfunction
Pregnancy and Breastfeeding

68
Q

PACU (Post Anaesthesia Care Unit)
What is post anaesthesia care?

A

Steps taken after the completion of a surgical procedure to manage a patient who has received general anaesthesia or sedation

69
Q

What are the 4 goals of Post Anesthesia Care

A

To reduce postoperative adverse events
To provide a uniform assessment of recovery
To improve post anaesthetics quality of life
To streamline postoperative care and discharge criteria

70
Q

What are 4 reasons that patients should be given oxygen in the postoperative period?

A

To counter effects of diffusion hypoxia when nitrous oxide is used

Compensate for hypoventilation

Compensate for V/Q mismatch

Meet the increased oxygen demand when shivering

71
Q

List 2 techniques of administration of postoperative analgesia

A

Patient Controlled Analgesia (PCA)
Regional Analgesics Technique (nerve block, epidural analgesia)

72
Q

List 8 criteria for discharge of patients from the post anaesthesia care unit

A

Fully conscious - able to maintain airway
CVS stable
Pain and PONV controlled
Temperature acceptable
IV Cannulae patent (flushed to remove residual anaesthesia)
All surgical drains and catheters checked
All health records and medical notes completed

Anaesthesiology (10 decks)

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