Preoperative Assessment

Question 1

Describe the American Society of anesthesiologists physical status classification of patients.

Answer 1

1. Normal, healthy patient.
2. Patient with mild systemic disease (no functional limitations).
3. Patient with severe systemic disease (some functional limitations).
4. Patient with severe systemic disease that is a constant threat to life (functionally incapacitated).
5. Moribund patient who is not expected to survive without the operation.
6. Brain-dead patient whose organs are being removed for donor purposes.
   E. Denotes emergency procedure.

Question 2

What patients (identified at the pre-operative assessment) are at increased risk of requiring preoperative or postoperative interventions to avoid respiratory complications (according to the American College of Physicians)?

Answer 2

1. Age > 60 years
2. Presence of COPD
3. Markedly reduced exercise tolerance
4. Functional dependence
5. Heart failure
6. ASA 3 or 4
7. Cigarette smoking
8. Surgery lasting > 4 hours
9. Abdominal, thoracic, head and neck and emergency surgery.

Question 3

What three important coagulation issues need to be assessed at the preoperative assessment?

Answer 3

1. How to manage patients who are taking warfarin or other long-caring anticoagulants on a long-term basis.
2. How to manage patients with coronary artery disease who are taking clopidogrel or related agents.
3. Whether one can safely offer neuraxial anaesthesia to patients who are receiving long-term anticoagulation therapy or who will receive anticoagulation perioperatively.

Question 4

What are the features that make pre-operative testing valuable?

Answer 4

There must be an avoidable increased perioperative risk if the results are abnormal (and the risk will remain unknown if the test is not performed), and when testing fails to detect the abnormality (or it has been corrected) there must be a reduced risk.

Question 5

What four elements must be established for a claim of negligence to be made?

Answer 5

1. Duty - that the physician established a duty of care with the patient.
2. Breach of duty - that these obligations were not fulfilled.
3. Injury - that the above resulted in injury (pain or suffering, loss of income etc.)
4. Causation - the breach of duty was the proximate cause of the injury.

Question 6

What factors influence the likelihood of a malpractice suit?

Answer 6

1. the physician patient relationship
2. the adequacy of informed consent
3. the quality of documentation