Preoperative assessment Flashcards
why are patients assessed (5)
- Assess the risks in administering an anaesthetic
- Patient’s condition is optimised for surgery
- Assist both the patient and the hospital
- Investigations performed in a timely manner before
anaesthetic and surgery - Informed consent taken with discussion of risks and
benefits and time for questions
what is the first stage of pre-operative assessment
screening
what is the goal of screening
to filter out the emergency from the elective anesthesia cases
what is emergency anesthesia
Surgery/anesthesia within 24 hours to save a life
what do you do for emergency anesthesia (2)
- lemon assessment
- rapid sequence induction (RSI)
what comprises the rapid sequence induction (4)
- pre-oxygenation
- IV induction
- muscle relaxation
- trachael intubation +/- cricoid pressure to prevent gastric aspiration into the lungs
what other things should you have available for emergency anesthesia (3)
- Suctioning ready
- 2 laryngoscopes
- ET-tubes
what is the purpose of pre- op assessment
to focus on the health issues relevant to anesthesia and post operative stay- not to make a diagnosis/ elicit a detailed history
what things are asked in pre op history (9)
- Brief
- PC
- procedure to be done
- confirm site of the procedure - Past Medical hx- CVS, RS, Renal disease, Endocrine, SCD, LNMP
- Surgical history
- Previous operations
- What procedures
- Site
- Reason
- complications - Previous anesthetics Hx
- Any anaesthesia prior to this
- Any complications
- Well being post operatively
- Post op nausea and vomiting - Drug hx and allergies
- Family history
- Conditions that lead to muscle rigidity despite neuro muscular blockade
- Malignant hyperthermia - Social history
- Alcohol
- smoking
- substance abuse - last intake of food & drink
- Systems review current medications
when doing a pre op examination what do you do (8)
- Nutrition status – obesity, malnutrition
- Skin colour – pale, blue, yellow
- MSE- mental status exam
- Airway assessment
- hydration status– IV fluids
- Cardiovascular System
- Respiratory system
- System to be operated on
** However the ideal is :
- General examination relating with the pathology
- Airway examination to assess how difficult intubation will be
what do you use for surgery grading (6)
- ASA 1– Normal healthy patient (0.1%)
- ASA 2- A mild systemic disease. i.e: Mild diabetes. (0.2%)
- ASA 3 - Severe systemic disease from any cause or causes. Example: Complicated or
severe diabetes. (1.8%) - ASA 4 - Severe systemic disease that is a constant threat to life regardless of the type of treatment.
(7.8%) - ASA 5 - Moribund, who is not expected to survive without the operation (9.4%)
- ASA 6 - Brain-dead organ donor
- E- Suffix added if its an emergency operation. i.e: an ASA 1 patient having an emergent procedure would be ASA 1E
what is the lemon law for airway assessment
L- look
E- evaluate
M- mallampati
O- obstruction
N- neck mobility
during Look in lemon what do (8)
Check for:
- facial trauma
- large incisors
- large tongue
- short neck
- obesity
- dentures
- burns
- stridor
what do you evaluate for in LEMON (3)
3-3-2
1. 3 fingers of the patient fit between incisors
2. 3 fingers from the tip of the chin (mentum) to the hyoid bone
3. 2 fingers between hyoid bone and superior thyroid notch
what are the grades for the mallampati (4)
Class I: complete visualization of soft palate
Class II: complete visualization of uvula
Class III: visualization of only the base of the uvula
Class IV: soft palate is not visible at all
during obstruction of LEMON what do you look for (4)
Patients are evaluated for:
- vomitus
- teeth
- sub-and supraglottic obstructions including tumours, abscesses, inflamed epiglottis, or
expanding hematoma
dentures
how do you assess neck mobility and what do the measurements mean (3)
- Measure from the upper edge of thyroid cartilage to the mentum while the neck is fully extended
- A short thyro-mental equals an anterior pharynx
- More than 7cm means easier intubation
what guides the pre-op investigations and plan (30
- Depends on co-morbidities
- age
- type of procedure
- they are not all ordered routinely
what makes up the pre-op investigations and plan (8)
- Blood tests:
- FBC
- U&E’s
- LFTS
- coagulation screen and
G&M/G&S
- RBS
- Sickle cell testing - Imaging:
- CXR
- ECG
- Cardiac Echo - Pulmonary function tests & Arterial blood gases
- Urinalysis
- MRSA screening
- Pregnancy test
- Informed consent
- Pre-op medication
what are the fasting guidelines for elective adults (3)
- Clear fluids and water up to 2 hours preoperatively
- Food, sweets and milky drinks up to 6 hours preoperatively (8 hours for heavy meals)
- No chewing gum on day of surgery
what are the fasting guidelines for elective children (4)
- Clear fluids and water up to 2 hours preoperatively
- Breast milk up to 4 hours preoperatively
- Formula/cow’s milk up to 6 hours preoperatively
- Food and sweets up to 6 hours preoperatively
what makes up the management plan (5)
- Reassure the patient
- Advise
- Prescribe
- Refer
- Observe
How long before surgery should a patient have a
preoperative assessment?
2-4 weeks
What classification is used to assess pontential difficulty for
airway intubation
Mallampati score
which prescriptions should be stopped before surgery (4)
- Clopidogrel 7 days prior
- Hypoglycemics
- OCPs -4 weeks
- Warfarin 5 days
what prescription can be started (2)
- Low molecular weight heparin
- Antibiotic prophylaxis
