Pre-operative Care

Question 1

What is the purpose of pre operative assessment?

Answer 1

To ensure the patient is fit for the surgery they are requiring

Question 2

What is involved in the pre op assessment?

Answer 2

Full past medical history
Current medications
Drug allergies
Smoking status
Alcohol status 
Previous surgery
Previous reactions to anaesthesia
If the patient is pregnant

Question 3

What is the ASA classification?

Answer 3

Determines the riskiness of the patient having anaesthesia

Question 4

What are the different rankings of the ASA classification?

Answer 4

1- healthy patient
2- mild systemic disease e.g. well controlled HTN
3- severe systemic disease e.g. BMI >40 or uncontrolled HTN
4- severe systemic disease tha tis constant threat to life e.g. recent MI
5- moribound patient who needs operation to survive e.g. ruptured AAA
6- brain dead patient whose organs are being harvested for donation

Question 5

What pre op investigations are needed?

Answer 5

Depends on each individual

ECG- if confirmed or potential CVD
Echo- in HF and murmurs
Lung function testing- confirmed or potential lung disease
ABG
U&Es- risk of AKI or on diuretics 
Clotting- in liver disease
FBC- risk of anaemia 
HbA1c- done within 3 months in diabetics 

All patients must have group and save done

Crossmatch in urgent situations

MRSA screen done by nurses

Question 6

When should a patient awaiting surgery be NBM?

Answer 6

6hours before surgery for food

2 hours before surgery for clear fluids

Question 7

When should warfarin be stopped pre op?

Answer 7

5 days before surgery

Can give heparin infusion or LMWH in the meantime

Question 8

When should COCP be stopped for surgery?

Answer 8

4 weeks before surgery

Question 9

When should DOACs be stopped for surgery?

Answer 9

24-72hrs before

Question 10

What should happen with steroids in surgery?

Answer 10

If on >10mg daily then should be switched to hydrocortisone for 24 hours

Question 11

What diabetic medication should be stopped pre operatively?

Answer 11

Sulphonylureas and SGLT2 inhibitors should be stopped the day of surgery and re started once patient is eating and drinking

Question 12

Can metformin be continued before surgery?

Answer 12

If patient is only missing one meal, has good eGFR and not at risk of AKI then it can be continued

If not it should be stopped