Anaesthetics Pre-op assessment Flashcards

1
Q

What do you want to find out about when taking a history / exam before anaesthesia?

A
  • Known co-morbidities
  • Unknown co-morbidities
  • Stress tolerance
  • Drugs & Allergies
  • Past surgery and anaesthesia
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2
Q

How do we look for unknown co-morbidities?

A

With a full systemic enquiry and exam

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3
Q

What specific areas would we ask about/examine when thinking about problems with anaesthesia?

A
Airway
Spine
Reflux
Obesity
H/o or Fh/o malignant hyperpyrexia or cholinesterase deficiency
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4
Q

How do anaesthetists grade patients prior to surgery?

A
Using the ASA grading:
1 = otherwise healthy
2 = mild/mod systemic disturbance
3 - severe systemic disturbance
4 - life threatening disease
5 - Moribund
6 - Organ retrieval
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5
Q

What would we do to assess a patient’s stress tolerance prior to anaesthesia?

A

Exercise tolerance & reasons for any limitation

Investigate any cardio-respiratory disease

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6
Q

How do we grade a patient’s exercise tolerance?

A

METS - Measure of Exercise Tolerance before Surgery

It’s a scale of 1-9 based on ability to do increasingly difficult activities WITHOUT getting breathless

E.g.
METS2 = walking around the house
METS5 = climb a flight of stairs or walk up hill
METS8 = Run a short distance

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7
Q

After we’ve assessed a patient’s co-morbidities, drugs/allergies and stress tolerance. What do we need to do next?

A

Investigate any potential illnesses/risks with tests.

Optimise medical control
Optimise lifestyle

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8
Q

What’s included in optimising the patient’s medical control?

A

optimise diabetic control
BP control
HF etc..
Some illnesses need to be well controlled to make surgery viable

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9
Q

Whats included in optimising the patient’s lifestyle prior to surgery?

A
  • Smoking
  • Alcohol
  • Obesity
  • Pre-habilitation (exercise). Its been shown that there’s a 15% reduction in mortality for every METS point you go up
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10
Q

What do we do about a patient’s medications when they undergo surgery?

A

Some should be kept on as normal e.g. inhalers, anti-anginals or anti-epileptics

Some should be stopped e.g. DM meds or anti-coagulants

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11
Q

Obviously with high-risk emergency patient’s we can’t go through the whole thing. What do we do?

A
  • Informed Consent
  • Anaesthetic Plan
  • Invasive monitoring
  • Senior management
  • Post-op critical care
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12
Q

what are the guideline of investigations

A
•	ASA grade
•	Surgery grade 
1.	Minor 
2.	Intermediate 
3.	Major 
4.	Complex
•	Co-morbidities
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13
Q

What is the point of having pre-op assessment

A
Reduces 
•	Anxiety
•	Delays 
•	Cancellations
•	Complications e.g. drinking a smoking should be stopped to prevent complications in a cardiac bypass 
•	Length of stay 
•	Mortality
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14
Q

post-op care classification

A

Can be classified depending on what level of attention they may require

0: Normal ward
1: normal ward with a bit more attention
2: HDU
3: Still need to be on a ventilator after op– ICU

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