Preoperative Assessment and Preparation Flashcards
What are the roles of anaesthetists?
Planned and emergency surgery Peri-operative medicine Pain medicine Resuscitation and stabilisation Critical care Pre-hospital/retrieval medicine Hyperbaric medicine
What are the roles of anaesthetists pre-op?
Assess Identify high risk Optimise Minimise risk Inform and support patients decisions Consent
What are the most important aspects of the patients history in the pre-op assessment?
Known co-morbidities - severity, control
Unknown co-mordbidities - systematic enquiry, clinical examination
Ability to withstand stress - exercise tolerance, reason for limitation, cardio-respiratory disease
Drugs and allergies
Previous surgery and anaesthesia
What features of the patient could pose a potential anaesthetic problem?
Airway - receding chin, small mouth, protruding teeth
Spine - scoliosis, previous back surgery
Reflux
Obesity - airway, CVS and respiratory changes
Rarities/family history - malignant hyperpyrexia, cholinesterase deficiency etc.
What questions could you ask to ascertain someone’s exercise tolerance?
METs
What are the METs?
Can you do the following activities without getting breathless;
Walk around the house
Do light housework
Walk 100-200 metres on flat ground
Climb a flight of stairs or walk up a hill
Walk on the flat at a brisk pace
Play golf, mountain walk, dance, or any form of exercise
Run a short distance
Do either strenuous or heavy physical work
What are the ASA gradings?
ASA1 - otherwise healthy patient ASA2 - mild to moderate systemic disturbance ASA3 - severe systemic disturbance ASA4 - life threatening disease ASA5 - moribund patient ASA6 - organ retrieval
What are the components of the cardiac risk index?
High risk surgery Ischaemic heart disease Congestive heart failure Cerebrovascular disease Diabetes Renal failure
What are the uses of investigation pre-operatively?
Detect unknown conditions Diagnose suspected conditions Severity of known disease Establishing a baseline Detecting complications Assessing risk Guiding management Document improvement Sensitivity and specificity Target those at risk
What do investigations vary depending on?
Vary from patient to patient depending on the type of surgery being undertaken and patient co-morbidities
What cardiovascular investigations might be done?
ECG Exercise tolerance test Echo Myocardial perfusion scan Stress echo Cardiac catheterisation CT coronary angiogram
What respiratory investigations might be done?
Saturations ABG CXR Peak flow measurements FVC/FEV Gas transfer CT chest
What conditions should be optimised to provide optimal medical control during anaesthesia and surgery?
Hypertension Ischaemic heart disease Heart failure Asthma COPD Diabetes Epilepsy
What medications is it particularly important to continue pre-operatively?
Inhalers
Anti-anginals
Anti-epileptics
What medications might need to be stopped/changed pre-operatively?
Anti-diabetic medication
Anticoagulation
