Preop assessment

Question 1

Why do you do pre-op assessment?

Answer 1

Identify risk to airway, anaesthetic and post op risks
Modify risks
Make decisions on medication
Give advice on fasting
Make decisions on post-op care

Question 2

When do you do the pre-op?

Answer 2

2-4 weeks before surgery so it’s long enough to arrange any further investigations, but soon enough to avoid any interim medical problems

Question 3

History

Answer 3

What is the procedure? 
PMH
Previous surgery/anaesthetics + any problems 
Systems review
Medication
Allergies
SH 
FH

Question 4

What problems might you ask about when asking about previous surgery?

Answer 4

Airway/intubation problems
Reaction to drugs
N/V post op

Question 5

What systems will you review?

Answer 5

Respiratory
Cardiac
Renal
Endocrine

Question 6

What will you ask about socially?

Answer 6

Smoking
Alcohol - are they at risk of withdrawal?
Recreational drugs
Support at home/work

Question 7

What would you be looking out for in FH?

Answer 7

Malignant hyperpyrexia

Myasthenia gravis

Question 8

What is the problem with malignant hyperpyrexia?

Answer 8

Pt becomes dangerously hyperthermic when administered with certain volatile agents

Question 9

What score is calculated?

Answer 9

American society anestheisa

Question 10

What are the stages of ASA and what do they stand for?

Answer 10

1 - healthy patient, uncompromised
2 - minor disease
3 - severe systemic disease
4 - severe systemic disease with a constant threat to life

Question 11

What counts as minor surgery?

Answer 11

Skin lesions

Breast abscess

Question 12

Intermediate surgery

Answer 12

Varicose veins
Knee arthroscopy
Inguinal hernias (primary)

Question 13

Major

Answer 13

Thyroidectomy
Colonic resection
Joint replacement
Adrenalectomy

Question 14

Major plus

Answer 14

Cardiac surgery

Question 15

What do you do after taking a history?

Answer 15

Obs 
Airway atm 
CV assessment
Resp
Abdo potentially

Question 16

What counts as obs?

Answer 16

HR
BP
Temp
O2 sats at rest

Question 17

What counts as airway assessment?

Answer 17

Neck extension/flexion
Mouth opening
Mallapati
Jaw protrusion

Question 18

What questions are you going to ask them for the airway assessment?

Answer 18

Can you touch your chin to your chest?
How far can you open your mouth?
Can you get your bottom teeth in front of your top teeth?

Question 19

What grading score is used to assess how easy it will be to put an endotracheal tube into the mouth?

Answer 19

Mallampati grading

Question 20

Mallamapti score 1

Answer 20

Hard palate
Soft palate
Uvula
All pillars

Question 21

Mallamapti score 2

Answer 21

hard palate
Soft palate
Uvula

Question 22

Mallamapti score 3

Answer 22

Hard palate and soft palate

Question 23

Mallamapti score 4

Answer 23

Hard palate only seen

Question 24

What do you do after this scoring?

Answer 24

Special routine tests e.g. FBC, clotting, renal function, lung function, ABGs, ecg, kidney function tests

Question 25

What is the age cut of after which you'd definitely arrange an ECG?

Answer 25

65

Question 26

If someone is taking BP meds, what tests do you need to do?

Answer 26

U and E

Question 27

If someone is taking antiplatelet meds, what tests do you need to do?

Answer 27

FBC

Question 28

If someone is taking anticoagulants meds, what tests do you need to do?

Answer 28

FBC and coagulation

Question 29

If someone is taking diabetes meds, what tests do you need to do?

Answer 29

HbA1c

Question 30

If someone is taking thyroid meds, what tests do you need to do?

Answer 30

TFTs

Question 31

If someone is taking anaemia meds, what tests do you need to do?

Answer 31

FBC

Question 32

When do you do a pregnany test?

Answer 32

If pt agrees to ad could be pregnant

Question 33

When do you do a HbA1c test?

Answer 33

Only if known diabetic and you don't have a result in the last three months

Question 34

When do you do a sickle test?

Answer 34

only if there is FH

Question 35

What meds might need modification during surgery?

Answer 35

Blood thinners Diabetic meds Antihypertensives

Question 36

Which antihypertensives need to be stopped?

Answer 36

Omit ACEi

Question 37

What is the general fasting advice?

Answer 37

Nil by mouth for 2 hours | Except for 30ls water with tablets

Question 38

Clear fluids

Answer 38

up to 2 hours before

Question 39

Solid food including milk

Answer 39

up to 6 hours

Question 40

What is the exception to this??

Answer 40

Delayed gastric emptying | emergency surgery

Question 41

If a diabetic patient has emergency surgery, what insulin do you give them?

Answer 41

variable rate insulin e.g. Actrapid??

Question 42

??

Answer 42

Look up the other things about diabetes and surgery