Preoperative Assessment

Question 1

How long should you wait before anesthetic administration after intake of solid food?

Answer 1

6 hours

Same as after ingestion of formula milk/non human milk

Question 2

How long should you wait before anesthetic administration after intake of breast milk?

Answer 2

4 hours

Question 3

How long should you wait before anesthetic administration after intake of clear fluids

Answer 3

2 hours

Question 4

Name three pharmacogenetic conditions relevant in anesthesia

Answer 4

Scoline apnoea
Malignant hyperthermia
Porphyrias

Question 5

State how long should you wait to perform the following surgeries:
a. Emergent
b. Urgent
c. Elective

Answer 5

• Emergency surgery: Must be done within the hour
• Urgent surgery: Must be done within 24 hours
• Elective surgery: A pre-determined booked time, no urgency

Question 6

Outline the Cape triage system categories

Answer 6

• Red: absolute emergency—must be done immediately
• Orange: Must be done within 1-3 hours
• Yellow: Must be done within 6 hours
• Green: “cold emergency”– must be done within 24 hours
• Blue: Elective surgery

Question 7

Give 3 examples that require emergent surgery

Answer 7

Unstable bleeding gunshot,
Imminently threatened airways,
Ruptured aortic aneurysm

Question 8

Give 2 examples that deserve an orange triage color for surgery

Answer 8

Acute abdomen due to bowel perforation
Ectopic pregnancy threatening to rupture

Question 9

Give 2 examples that deserve an yellow triage color for surgery

Answer 9

Stable appendicitis,
Open fractures requiring washing out

Question 10

Give 4 examples that deserve a green triage color for surgery

Answer 10

stable, closed fractures, changing of
dressings, cancer surgery

Question 11

Is the urgency of surgery the same concept as the ASA classification? Why or why not?

Answer 11

Nope

The ASA classification attempts to assign risk to a patient based on their baseline state

Example: You could have a healthy patient (ASA 1) presenting for extremely urgent surgery (ruptured ectopic pregnancy) or a very ill patient with a poor baseline (ASA 4) presenting for elective surgery (cataracts), or any other combination.

Question 12

List 7 common targets of preoperative optimization

Answer 12

Fluid balance
Electrolyte abnormalities
Diabetes
Infections
Heart failure
Anemia
Bronchospasm

Question 13

What is the desirable level of sodium preoperative?

Answer 13

130-145

Anything high or low requires correction

Question 14

For how long should a smoker stop smoking before an elective surgery?

Answer 14

8 weeks: Reduces postoperative lung complications

Question 15

Is a patient allowed to smoke before surgery?

Answer 15

Nope, this reduces nicotine stimulant effects on CVS

Question 16

Who can give consent for a surgical procedure to be done on them?

Answer 16

Anyone older than 18 years old
And
Married people below 18 years old

Question 17

Who can give consent for HIV testing?

Answer 17

Anyone who is at least 12 years old

Question 18

Can patients who are 14 years old give consent for medical procedures?

Answer 18

Yes but not a surgical procedure

Question 19

Who is allowed to be a witness for consenting for a surgical procedure?

Answer 19

Anyone who is at least 16 years old

Note: Surgeons are not allowed

Question 20

How many people should witness the consent for a surgery?

Answer 20

The doctor and at least 2 other people

Note: Members of the surgery team and anaesthetist are not allowed to be witnesses

Question 21

8 people who are at high risk for post-op pulmonary complications

Answer 21

• Chronic obstructive lung disease
• Markedly reduced exercise tolerance and functional dependence
• Heart failure
• ASA class (class 3 and 4 patients have a markedly increased risk)
• cigarette smoking
• Longer surgeries (>4 h)
• Certain types of surgery (abdominal, thoracic, aortic aneurysm, head and neck, and emergency
surgery)
• General anaesthesia

Question 22

List 4 risk reduction strategies to prevent post-op pulmonary complications

Answer 22

• Cessation of cigarette smoking prior to surgery
• Lung expansion techniques (e.g., incentive spirometry) after surgery
• Patients with asthma, particularly those receiving suboptimal medical management, havea greater risk for bronchospasm during airway manipulation.
• Appropriate use of analgesia and monitoring are key strategies for avoiding postoperative respiratory depression in patients with obstructive sleep apnoea.

Question 23

Can the American association of anaesthesiology classification be used for children?

Answer 23

Nope

Question 24

What are the limitations of the ASA classification? 3

Answer 24

Does not account for extreme of ages either elderly or children
Does work well in morbidly obese people
Does not consider potentially difficult airway

Question 25

Outline the American Association of Anaesthesiology classes

Answer 25

CLASS I A normal healthy patient CLASS II A patient with mild systemic disease CLASS III A patient with severe systemic disease CLASS IV A patient with severe systemic disease that is a constant threat to life CLASS V A moribund patient who is not expected to survive with or without the operation In addition the letter E is applied if the operation is an emergency. Class V is always an “E” CLASS VI A declared brain-dead patient whose organs are being removed for transplant

Question 26

State two commonest fears with regards to anesthetics

Answer 26

Awareness during the procedure and not waking up again

Question 28

Name a score used to predict the risk of difficulty airway management. Outline how it is done.

Answer 28

Mallampati airway classification How it is performed: Ask the patient to open their mouth widely and protrude their tongue and you check for the visibility of the uvula and pillars.

Question 30

Name two conditions that are worth asking the family history of in anaesthesia.

Answer 30

Malignant hyperthermia Scoline apnoea(Pseudocholinesterase deficiency)

Question 31

An anesthetic evaluation prior to surgery should include

Answer 31

the patient’shistory regarding their response to previous anesthetics, NPO status, presence or absence of gastric reflux, difficulty or ease of airway management, history or family history of malignant hyperthermia or pseudocholinesterase deficiency, an examination of the oral cavity, airway and neck mobility, and the ease of i.v. access.

Question 32

Name a useful indicator of the risk of surgical mortality.

Answer 32

American Society of Anesthesiologist classification

Question 33

What is the predictor of difficulty or ease of intubation?

Answer 33

Mallampati airway classification