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Anaesthesia > Preoperative Evaluation > Flashcards

Preoperative Evaluation Flashcards

1
Q

What is the preoperative history we would take in cases of emergency?

A

AMPLE

  • Allergies
  • Medications
  • Past medical history
  • Last meal
  • Events leading up to problem
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2
Q

What are the areas of key information that we want to assess in a history for the preoperative evaluation?

A
  • History of presenting illness
  • Anesthetic history
  • Review of systems
  • Allergies
  • Current medication
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3
Q

For the history of presenting illness for the preoperative evaluation, what do we want to ask about?

A
  • Understand the reason for surgery
  • The severity of the problem
  • Any therapeutic interventions that
    have been used
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4
Q

For the anesthetic history of the preoperative evaluatin, what do we want to ask about?

A
  • Understand negative reactions to previous anesthetic
  • Ask about FHx of negative reactions to previous anesthetic (e.g., malignant hyperthermia, plasma
    cholinesterase deficiency)
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5
Q

For the review of systems history, what is the functional capacity?

A

o Functional capacity is a powerful predictor of postoperative cardiopulmonary and
neurocognitive complications. This is based on exercise tolerance.

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6
Q

How is functional capacity measured?

A

1 MET = consumption of 3.5 ml O2/kg/min

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7
Q

What is the value for poor exercise tolerance for functional capacity?

A

< 4 MET = poor exercise tolerance

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8
Q

What is MET 1 for functional capacity?

A

Eating, dressing

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9
Q

What is MET 2 for functional capacity?

A

Walking down stairs or in house

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10
Q

What is MET 3 for functional capacity?

A

Walking 1-2 blocks

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11
Q

What is MET 4 for functional capacity?

A

Raking leaves

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12
Q

What is MET 5 for functional capacity?

A

Climbing 1 flight of stairs

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13
Q

What is MET 6 for functional capacity?

A

Playing golf

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14
Q

What is MET 7 for functional capacity?

A

Playing tennis

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15
Q

What is MET 8 for functional capacity?

A

Slowly jogging

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16
Q

What is MET 9 for functional capacity?

A

Slowly jumping

17
Q

What is MET 10 for functional capacity?

A

Briskly jogging

18
Q

What is MET 11 for functional capacity?

A

Running for mild-moderate distances

19
Q

What is MET 12 for functional capacity?

A

Running for moderate-long distances

20
Q

What are the four conditions we want to ask about for the cardiovascular system review?

A
  • CAD
  • CHF
  • Valvular disease
  • Pacemaker/implantable cardioverter-defribillator
21
Q

What does coronary artery disease (CAD) increase the risk for with anaesthesia? Who is this highest in risk for?

A

CAD increases the risk of perioperative myocardial ischemia or infarction; this risk is
highest in patients with a recent MI or UA

22
Q

What do we have to ask for in treatment strategies in patients with a previous MI?

A

Patients with a coronary stent placed within the preceding year are at increased risk for perioperative MI

23
Q

How long do we have to wait for a patient who has undergone an MI and wants to do elective surgery to receive anaesthetic?

A

Elective surgeries should not occur within 6 months of a MI

24
Q

For patients with coronary artery disease, which medications should we continue and why?

A

Continue anti-anginal medications to maintain organ perfusion and decreased afterload

25
Q

What is class I for the functional classification of angina?

A

Angina with strenuous activity

26
Q

What is class II for the functional classification of angina?

A

Angina with walking > 2 blocks, climbing > 1 flight of stairs, or emotional stress

27
Q

What is class III for the functional classification of angina?

A

Angina with walking < 2 blocks or climbing < 1 flight of stairs

28
Q

What is class III for the functional classification of angina?

A

Angina with all activity +/- at rest

29
Q

Why is it important to ask about congestive heart failure for the preoperative evaluation?

A

CHF is an important risk factor of perioperative morbidity and mortality

30
Q

What are the CHF symptoms to ask for?

A

Ask about CHF symptoms: fatigue, syncope, dyspnea, orthopnea, PND, cough

31
Q

What is class I for the functional classification for heart failure?

A

Ordinary physical activity does not cause CHF symptoms

32
Q

What is class II for the functional classification for heart failure?

A

Ordinary activity causes CHF symptoms

33
Q

What is class III for the functional classification for heart failure?

A

Less than ordinary activity causes CHF symptoms

34
Q

What is class IV for the functional classification for heart failure?

A

All activity causes CHF symptoms +/- at rest

Anaesthesia (8 decks)

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