Preop assessment Flashcards
Why do you do pre-op assessment?
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
When do you do the pre-op?
2-4 weeks before surgery so it’s long enough to arrange any further investigations, but soon enough to avoid any interim medical problems
History
What is the procedure? PMH Previous surgery/anaesthetics + any problems Systems review Medication Allergies SH FH
What problems might you ask about when asking about previous surgery?
Airway/intubation problems
Reaction to drugs
N/V post op
What systems will you review?
Respiratory
Cardiac
Renal
Endocrine
What will you ask about socially?
Smoking
Alcohol - are they at risk of withdrawal?
Recreational drugs
Support at home/work
What would you be looking out for in FH?
Malignant hyperpyrexia
Myasthenia gravis
What is the problem with malignant hyperpyrexia?
Pt becomes dangerously hyperthermic when administered with certain volatile agents
What score is calculated?
American society anestheisa
What are the stages of ASA and what do they stand for?
1 - healthy patient, uncompromised
2 - minor disease
3 - severe systemic disease
4 - severe systemic disease with a constant threat to life
What counts as minor surgery?
Skin lesions
Breast abscess
Intermediate surgery
Varicose veins
Knee arthroscopy
Inguinal hernias (primary)
Major
Thyroidectomy
Colonic resection
Joint replacement
Adrenalectomy
Major plus
Cardiac surgery
What do you do after taking a history?
Obs Airway atm CV assessment Resp Abdo potentially
What counts as obs?
HR
BP
Temp
O2 sats at rest
What counts as airway assessment?
Neck extension/flexion
Mouth opening
Mallapati
Jaw protrusion
What questions are you going to ask them for the airway assessment?
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?
What grading score is used to assess how easy it will be to put an endotracheal tube into the mouth?
Mallampati grading
Mallamapti score 1
Hard palate
Soft palate
Uvula
All pillars
Mallamapti score 2
hard palate
Soft palate
Uvula
Mallamapti score 3
Hard palate and soft palate
Mallamapti score 4
Hard palate only seen
What do you do after this scoring?
Special routine tests e.g. FBC, clotting, renal function, lung function, ABGs, ecg, kidney function tests
What is the age cut of after which you’d definitely arrange an ECG?
65
If someone is taking BP meds, what tests do you need to do?
U and E
If someone is taking antiplatelet meds, what tests do you need to do?
FBC
If someone is taking anticoagulants meds, what tests do you need to do?
FBC and coagulation
If someone is taking diabetes meds, what tests do you need to do?
HbA1c
If someone is taking thyroid meds, what tests do you need to do?
TFTs
If someone is taking anaemia meds, what tests do you need to do?
FBC
When do you do a pregnany test?
If pt agrees to ad could be pregnant
When do you do a HbA1c test?
Only if known diabetic and you don’t have a result in the last three months
When do you do a sickle test?
only if there is FH
What meds might need modification during surgery?
Blood thinners
Diabetic meds
Antihypertensives
Which antihypertensives need to be stopped?
Omit ACEi
What is the general fasting advice?
Nil by mouth for 2 hours
Except for 30ls water with tablets
Clear fluids
up to 2 hours before
Solid food including milk
up to 6 hours
What is the exception to this??
Delayed gastric emptying
emergency surgery
If a diabetic patient has emergency surgery, what insulin do you give them?
variable rate insulin e.g. Actrapid??
??
Look up the other things about diabetes and surgery
