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Preoperative assessment Flashcards

1
Q

What is the end goal of preoperative assessment?

A

Formulation of the anaesthetic plan

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2
Q

List 5 goals or aims of the preoperative assessment

A

To formulate the anaesthetic plan
To understand the patient baseline physiological state
To identify any risk factors
To identify conditions which can be optimised prior to surgery
To prepare the patient psychologically

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3
Q

Name three systems that should be examined in the preoperative assessment prior to surgery

A

Airway(vital), respiratory and cardiovascular systems

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4
Q

List 4 important information that should be obtained from the patient medical history

A

Comorbidities
Medications
Allergies
Family history of malignant hyperthermia or scoline apnoea.

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5
Q

Is asking about prior surgeries and anaesthesia history important in the preoperative assessment?

A

Yes.

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6
Q

Where and whenshould the patient undergoing an elective surgery be seen?

A

Day before in the ward or in the morning of surgery

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7
Q

Where should patients undergoing an urgent/emergency surgery be seen?

A

Front room/Induction room

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8
Q

Who can be rushed into theatre for surgery?

A

Critically ill patients requiring immediate surgery

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9
Q

List 4 surgical considerations that should be established in a preoperative assessment.

A

Urgency of the surgery
Type of procedure
Location of procedure
Positioning

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10
Q

List 7 important history that should be obtained from the patient

A

Current problem
Co-morbidmdisease
Medication history
Previous anaesthetics
Relevant family history
Systemic reviews
Last oral intake

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11
Q

How long should a patient wait for surgery after intake of solid food or formula milk?

A

6 hours

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12
Q

How long should a patient wait before surgery after intake of breast milk

A

4 hours

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13
Q
A
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14
Q

How long should a patient wait before surgery after intake of clear fluids?

A

2 hours

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15
Q

List 6 risk factors for aspiration during anaesthesia.

A

Pregnancy
Full stomach
Increased intra abdominal pressure
Autonomic neuropathy in diabetics
Gastric pathologies such as PUD, hiatus hernia and GORD
Renal failure

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16
Q

List 4 conditions that increase intra-abdominal pressure that increases the risk of aspiration.

A

Obesity
Bowel obstruction and mases
Ascites

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17
Q

Name three things that should be established about the last oral intake before surgery.

A

Time since the meal
Time since trauma or injury
Any other risk factors for a full stomach

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18
Q

Outline the ASA mortality classification.

A
  1. Normal healthy individual
  2. Mild systemic disease without limitations
  3. Mod to severe systemic disease with some limitations
  4. Severe systemic disease which is a constant threat to life
  5. Moribund patient who is not expected to live>24hours with or without the surgery
  6. Brain dead patient
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19
Q

What is the predicted mortality rate for ASA class 1?

A

0.06-0.08%

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20
Q

What is the predicted mortality rate for ASA class 3?

A

1.8-4.3%

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21
Q

What is the predicted mortality rate for ASA class 2?

A

0.27-0.4%

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22
Q

What is the predicted mortality rate for ASA class 4?

A

7.8-23%

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23
Q

What is the predicted mortality rate for ASA class 5?

A

9.4-51%

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24
Q

Name three factors that should guide special investigations to be done in preoperative assessment.

A

Age, comorbidities and planned procedure

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25
List 4 components of an anaesthetic plan
Premedication Type of anaesthesia Intraoperative management Postoperative care: Pain control and placement
26
List 6 components of intraoperative management in anaesthesia.
Monitoring Positioning Fluid management Airway management Special technique Drug choices
27
List 5 medications that can be given as premedication
Sedation Preemptive nalgesia Antiemetics Anxiolysis Regular medications
28
Is routine testing recommended in the preoperative assessment?
Nope: They are expensive and rarely alter the management
29
Routine testing should be guided by
History and physical exam
30
To be useful, preoperative testing must discriminate:
There must be an increased perioperative risk when the results are abnormal and there must be a reduced risk when the abnormality is not detected (or it has been corrected).
31
Name a preoperative test recommended for anemia
FBC
32
Name a preoperative test recommended for a healthy patient undergoing a minor surgery
Ward finger prick Hb
33
Name a preoperative test recommended for a patient with a history of surgical blood loss>300 ml
FBC
34
Name preoperative tests recommended for patients with well controlled diabetes, younger than 40 and undergoing a minor surgery
Ward Hb, Urine dipstick and blood glucose
35
Name preoperative tests recommended for patients with diabetes, older 40 or having a major surgery
Ward Hb, urine dipstick, blood glucose, U&E with creatinine, EKG and HbA1c
36
Name preoperative tests recommended for patients older than 45 or having a major surgery
Ward Hb, U&E with creatinine, EKG, Urine dipstick
37
38
Name preoperative tests recommended for patients undergoing a major vascular surgery
FBC, CXR, EKG, Blood glucose and U&E with creatinine
39
Name preoperative tests recommended for patients with cardiovascular disease
FBC, EKG, CXR, U&E with creatinine
40
Name preoperative tests recommended for patients with limiting respiratory disease
FBC, CXR, EKG, PFTs
41
Name preoperative tests recommended for patients with renal impairment
U&E with creatinine, FBC, EKG, Urine dipstick
42
Name preoperative tests recommended for patients with liver disease and right heart failure.
FBC, U&E with creatinine, CXR, EKG, Urine dipstix, Blood glucose, liver function tests and albumin and INR
43
Name preoperative tests recommended for patients who are morbidly obese.
FBC, U&E, CXR, EKG, Blood GLUCOSE, PFTs
44
Name preoperative tests recommended for patients undergoing thoracotomy
FBC, CXR, PFTs
45
Name preoperative tests recommended for patients with thyroid dysfunction
TSH and free T4
46
Name preoperative tests recommended for patients who are females of child bearing age.
Ward Hb and pregnancy test
47
Name preoperative tests recommended for patients on steroids(>10 mg per day)
Ward Hb and U&E
48
Name preoperative tests recommended for patients undergoing major abdominal surgery.
FBC
49
Should CXR <1 year be repeated for preoperative assessment?
Only if there is a change in symptoms
50
Should an ECG < 1 year old be repeated if symptoms stable
Nope
51
Should urea / creatinine & electrolytes be repeated if normal in previous 3 months & no new diuretics
Nope
52
4 indications for INR/PTT testing in the preoperative assessment.
All Patients on warfarin, Chronic liver disease, haemophilia, inherited platelet disorder
53
Indications for PFts in the preoperative assessment 2
Patients with uncharacterized dyspnoea or exercise intolerance that is unexplainable. Admission for respiratory aetiology or oral steroid use in last year
54
Name preoperative testing that should be done in an older or symptomatic asthmatic.
Pre and post bronchodilator spirometry
55
Should preoperative spirometry be done in a young asymptomatic asthmatic?
Nope
56
Name two preoperative tests for patients with severe COPD
Pre and post bronchodilator spirometry and blood gases
57
Name preoperative tests for hypertension
FBC, U&E, EKG, URINALYSIS
58
If a patient has a diastolic blood pressure of >=110 in the preoperative assessment, what should be done?
Refer to medicine for at least 2 weeks if they are supposed to have an elective surgery If it is an urgent surgery: Anaesthesia consultation is required
59
Name 7 conditions that require an anaesthetic consultation before surgery.
Severe COPD Previous lung surgery Patient with DBP>115 but requiring an urgent surgery Acute coronary syndrome now or MI in the past 6 months Cardiomyopathy Previous cardiac surgery Airway problems
60
Are premedication given routinely?
Nope only when necessary
61
What is the premedication used for anxiolysis?
Benzodiazepine
62
What is the premedication used for sedation?
Benzodiazepine and opioids
63
What is the premedication used for analgesia?
Opioids or and paracetamol
64
What is the premedication used for vomiting?
Phenothiazines, Butyrophenones and dexamethasone
65
What is the premedication antisialagogue?
Anticholinergics and phenothiazines
66
What is the premedication used for DVT?
Heparin, TED stockings and calf compression devices
67
What is the premedication used for bronchospasm?
Beta agonists
68
What is the premedication used for hypertension?
Beta blockers
69
What is the premedication used for cardiac ischemia?
Beta blockers, nitrates and statins
70
What is the premedication used for prevention of acid aspiration?
Sodium citrate, metoclopramide H2-antagonists (e.g. ranitidine, cimetidine), proton-pump inhibitors (e.g. omeprazole)
71
EMLA® or Ametopp® local anaesthetic cream application for venepuncture is also very useful in children and needle-phobic adults.
Cram

Anaesthesia 2.0 (9 decks)

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