Preoperative Assessment Flashcards
Aims of the preoperative visit
A) An ANAESTHETIC PLAN B) Patient’s BASELINE PHYSIOLOGIC STATE C) Identify any RISK FACTORS D) Identify any conditions (co-morbidities/Chronic Conditions) which can be OPTIMISED prior to surgery E) Prepare the patient psychologically
Patient considerations
a) Check Valid consent and documentation
b) Hx= Current problem; Co-morbid disease; Medication; Allergies; Family History (Malignant Hyperthermia); Last meal intake; Previous anaesthetics (including complication perioperatively)
c) Examination= CVS; Resp and AIRWAY and other relevant systems.
Last oral intake
Fried fatty foods= 8 Solid food & Formula milk=6 Breast Milk= 4 Clear Liquid= 2 N.B. TIME SINCE INJURY/TRAUMA AFFECTS (DECREASE) GASTRIC EMPTYING.
Surgical / Procedural considerations
a) Determine if surgery is urgent/ elective by assessing and evaluating time and risk of the procedure.
b) Type of procedure: Superficial / deep; duration; estimated blood loss
c) Location of procedure? (left vs right)
d) Positioning (supine, lateral, prone)
Types of Surgeries
- Elective surgery: patients may be seen the day before in the ward or in the morning of surgery
- Urgent / emergency surgery: patients often seen in front room / induction room, less time to assess
- Critically ill patients requiring immediate surgery may be rushed to theatre with little time to assess
Risk factors for aspiration (AUR-GAP)
a) Full stomach (unfasted)
b) Pregnancy
c) Increase Abdominal Pressure (Obesity;
Ascites; Bowel masses;
Bowel obstruction)
d) Gastric Pathology
e) Autonomic neuropathy
ALWAY INTUBATE
Special investigations
Guided by patients age, comorbidity and planned procedure.
Includes:
FBC
-U&E (e.g. hypertension/renal disease/elderly/acutely ill)
-Blood Group and Save/Crossmatch (e.g. major blood loss)
-ECG (e.g. elderly/cardiac pathology/hypertension/ischemic heart disease)
-CXR (e.g. respiratory and cardiovascular disease, elderly)
-Echocardiography (e.g. valve lesions/cardiac disease)
ASA Classification
Predicts Mortality Postoperative:
I: A normal healthy patient
II: A patient with mild systemic disease and no functional limitations
III: A patient with moderate to severe systemic disease that results in some functional limitation, but not incapacitating
IV: A patient with severe systemic disease that is a constant threat to life and incapacitatingT
V: A moribund (dying) patient that is not expected to live for more than 24 hours with or without the surgery
VI: A brain-dead patient whose organs are being harvested
E: If the procedure is an EMERGENCY, the physical status is followed by and “E”
ASA I
Healthy, non-smoking, no or minimal alcohol use.
ASA II
Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease.
ASA III
Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease
ASA IV
Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
ASA V
Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
Formulation of the anaesthetic plan
A)Premedication= Sedation; Anxiolysis; Regular medication; Preemptive analgesia; Antiemetics
B)Type of Anaesthesia= General; Regional/Local; Conscious sedation
C)Intraoperative Management= Monitoring; Positioning; Fluid management; Airway management; Special techniques; Drug choices
FS DAMP
D)Postoperative Care: Pain control
Placement (ward/HCU/ICU)
