Pre-op/post-op Flashcards
Some important PMH questions in a pre-op assessment
Cardiovascular disease - increased risk of cardiac event during anaesthesia, HF (lying flat), exercise tolerance
Respiratory disease - planning oxygenation
Renal disease - surgical complications (anaemia, coagulopathy, biochemical disturbances)
Endocrine disease - diabetes and thyroid(medication changes)
GORD
Falls/blackouts
Questions in post anaesthetic history
Previous anaesthesia? - Post op complications? Airway difficulties? Drug reactions?
What is malignant hyperpyrexia?
An autosomal dominant condition that leads initially to muscle rigidity despite neuromuscular blockade, followed by a rise in temperature
Whats the 2-4-6 rule?
Fasting rules:
2 hours clear fluids/tea/coffee,
4 hours breast milk
6 hours food
What score is used to describe how easy intubation will be?
Mallampati score
- degree of mouth opening, teeth, oropharynx, neck movement, thryomental distance
What score is used to assess the physical state of a patient before surgery?
The ASA score (1-4)
When should oxygen be given post op?
Until patient is fully awake
Reasons for ongoing oxygen therapy
Patient factors - obesity, age, cardiorespiratory
Physiological factors - anaemia, hypovolemia
Surgical factors - abdominal surgery, thoracic surgery
Analgesia - intrathecal opiods, PCS
Name 2 variable performance devices for oxygen
Non-rebreathe mask
Nasal cannulae
How many ml/min does a non-rebreathe mask give?
Up to 15l/min
How many ml/min does a nasal cannulas give?
1-4L/min
Name a fixed performance devices for oxygen
Venturi device
Contraindication to a nasopharyngeal airway
Significant facial and basilar skull fractures
Post op complications
Hypoxaemia, hypotension, arrhthmias, AKI, delerium, post op nausea and vomiting
Possible causes of post op hypoxaemia
Atelecatasia, bronchopneumonia, aspiration, pulmonary oedema, pneumothorax, PE, hypoventilation secondary to opiods
