Preoperative Assessment Flashcards
Outline the ASA scale for functional status
1: fit and healthy
2: mild systemic disease
3: severe systemic disease with physiologic disturbance affecting activity
4: severe disease with constant threat to life
5: moribund, unlikely to survive 24 hrs with or without surgery
What are the important components of examination in preoperative assessment?
Vital signs
ABCDE if in emergency
Examination related to surgical pathology
CV exam (focussing on veins)
Resp exam (assess airway function)
NS exam (especially at block site if relevant)
What Ix should be performed prior to surgery?
If fit and healthy: none
If pre-existing medical conditions: those relevant to illness
Group and hold if major blood loss anticipated
When should U&Es be ordered as part of the work-up?
PHx renal disease, diarrhoea, vomiting
Rx diuretics, steroids
When should LFTs be ordered as part of the work-up?
PHx liver disease, excess EtOH
What preoperative Ix should be ordered for the diabetic patient?
FBG
HbA1c
When should a coagulation profile be ordered preoperatively?
PHx coagulopathy, liver disease
Rx anticoagulants
Give examples of CV, respiratory, endocrine, renal and haematological conditions requiring assessment and optimisation prior to surgery
CV: arrhythmia, valvular heart disease, uncontrolled IHD, CCF or HTN
Resp: poorly controlled asthma, COPD with dyspnoea at rest, smoking (also has haematological considerations)
Endo: diabetes, thyroid disease
Renal: pts on dialysis
Haem: coagulopathy, anticoagulation, anaemia
Outline 4 minor risks of anaesthesia
Failed IV access
Injury related to airway management (e.g. cut lip, dental injury, sore throat)
Headache
PONV (post-operative N+V)
Outline 6 major risks of anaesthesia
Aspiration of gastric contents Hypoxic brain injury MI, stroke Nerve injury Chest infection Death
Give 6 common indications for pre-medication (6 A’s)
Anxiolytics Amnesia Analgesia Antacid prophylaxis Anti-sialagogue Already existing conditions (e.g. anti-anginals, antiHTNs, bronchodilators)
What are the guidelines for managing bleeding risk in anticoagulated pts?
Consider need to cease anticoagulant: if high risk of bleeding, stop warfarin 5 days pre-op and check INR before surgery
For emergency surgery, reverse with prothrombinex 50 IU/kg; may also need vit K and FFP
How should thrombus risk for anticoagulated pts be managed when there is a high risk of intraoperative bleeding?
If high risk, perform bridging therapy with clexane after ceasing warfarin (cease clexane 24 hrs before surgery), and recommence warfarin at usual dose post-op
List 3 methods of DVT prophylaxis
Compression stockings Mechanical calf compression devices Pharmacological intervention (anticoagulation)
What 5 factors are important when considering choice of anaesthetic technique?
Adequacy for planned surgery Safety Access it will provide for surgery Acceptability to pt Experience of the anaesthetist in a specialised technique
