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Anaesthesia > Preoperative Assessment > Flashcards

Preoperative Assessment Flashcards

1
Q

What happens in preoperative assessment clinic?

A

Consultant anaesthetist sit down with pt and assess fitness for surgery in elective cases. They go though the risks of surgery with the pt.

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2
Q

What is involved within the preoperative fitness assessment?

A

Cardiopulmonary fitness
-beware diabetes and renal impairment - more like to have post-op complications

Systematic approach

  • CVS/Resp/GI/GU/Neuro/other
  • physical activity assessment

Identify problems which could lead to cancellation on admission

Identify frailty and risk of delirium - increase length of hospital stay and peri-operative mortality

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3
Q

What are the things assessed for in cardiovascular preoperative assessment?

A
  • Hypertension - <180/110 hospital or 160/100 community, ECG signs: LVH (end organ damage)
  • AF - ventricular rate < 100, bisoprolol rate control - can be continued, anticoagulant - need to be stopped
  • pacemaker/ICD/CRT - last check, card
  • larger vessel disease - angina, CVA, PVD
  • Heart failure/cardiomyopathy - peripheral or pulmonary oedema, NT-Pro BNP, ECHO for LVEF, referral for cardiology optimisation may be necessary
  • Valvular disease - aortic stenosis (EVA < 1cm2 = severe)
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4
Q

What are the things assessed for in respiratory preoperative assessment?

A
  • Asthma- hospital or ICU admissions/ oral steroids/ NSAIDS - cause wheezing?/ PEFR
  • COPD - do spirometery - beware FEV1 < 1.0 L - may need ITU bed after surgery, discuss PaO2 <8, PaCO2>8 on room air
  • Obstructive sleep apnoea - STOP-BANG > 4 significant as very sensitive to opioid drugs which may result in marked resp distress and airway obstruction and anaesthetic use, may be need overnight screening oximetry to confirm OSA
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5
Q

What are the things assessed for in GI preoperative assessment?

A
  • Diabetes - type, normal treatment, control: glycated Hb < 69 for elective - if poorly controlled and increase risk of complications and death post-op
  • Liver disease - impaired coagulation, jaundice & ascites, hepato-renal risk. Drugs metabolised here
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6
Q

What are the things assessed for in GU preoperative assessment?

A
  • CKD - CKD 3 (eGFR<60) or worse increase risk or >100kg need to calculate creatinine clearance
  • BPH - Nocturia, risk of catheterisation
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7
Q

What are the things assessed for in neuromuscular preoperative assessment?

A

Epilepsy - may require longer admissions and not a daycase

MS and spinal injury - lung function: beware FEV1 < 1.0 L, L2 or L3 CCU bed postoperative

Myasthenia/myotonia - L2 bed postoperative

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8
Q

What is used to asses physical activity?

A

Duke activity status index

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9
Q

What is involved in frailty assessment?

A
  • Rockwood or Edmonton frailty score
  • frailty predicts prolonged stay
  • look for sarcopenia esp it’s obesity - muscle wasting
  • clock face = risk postoperative delirium
  • addenbrookes PRIME clinic - MDT clinic.
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10
Q

What cardiac investigations would be done in preoperative stage?

A

ECG - pt risk of IHD, CVS symptoms and signs

Echocardiograph- signs of HF, murmur plus abnormal ECG or symptoms, valvular pathology & no result in last 12 months

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11
Q

What resp investigation can be done in preoperative stage?

A

CXR

Spirometery

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12
Q

What bloods are done preoperative?

A

FBC - anaemia (Hb <120) = check ferritin, consider IV iron before major surgery
U&E - CKD 3: eGFR 30-59, CKD 4 15-29
LFTs - history of liver disease
Clotting
Thyroid function - history of thyroid disease

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13
Q

What medications may be adjusted/stopped preoperative?

A

Diabetic - insulin - miss no more then meal, SU and gliflozins stopped due to hypoglycaemic risk
Steroids - >5mg/day prednisolone may require hydrocortisone cover
Immunosuppressants- seek advise from rheumatology and transplant physicians
Anticoagulation - warfarin omit 5 doses, high risk VTE =bridging LMWH, DOACS stop 24/48 hrs before
Anti-platelets - aspirin: primary= stop 7-10 days before, if secondary - continue low dose, clopidogrel - stop 7 days before, ticagrelor - 5 days
Antihypetensive - ACEi/ARB - usually omit 24 hrs before, beta blockers continue

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14
Q

What is prehabilitation?

A

Fitter, better, sooner - things that can be done pre op to reduce post op complications:

  • exercise/weight loss - 6 weeks
  • smoking/alcohol - 4 week
  • Nutrition
  • relaxation/breathing exercises
  • psychological wellbeing
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15
Q

What are the two airway assessment scores are used?

A

Wilsons score - ease of laryngoscopy

Mallampati score - easy of endotracheal incubation

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16
Q

What are STOP drugs?

A

CHOW

Clopidogrel
Hypoglycaemic causing medicine
Oral contraceptive
Warfarin

17
Q

What drug are altered?

A

Subcutaneous insulin -

Long term steroids

18
Q

START drugs?

A

LMWH
TED stocking - exception vascular
Antibiotics prophylaxis’s

Anaesthesia (9 decks)

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