Perioperative care

Question 1

Patient initial assessment

Answer 1

History
Examination- GPE, S/E
Drug/ Surgery history (gives an idea of anesthesia)/ habits
Social history

Investigations-
CBC- anemia
HbA1c- In known diabetics if not done within the last 3 months
RFT
Serum electrolytes
LFT
Coag profile
ECG- >65 yrs/ symptomatic pt/ cardiac history
Ur R/E- Only if the infection will alter the decision to operate
ABG
Cross matching, blood grouping
CXR- If reqd
Echo- If symptomatic

Question 2

Airway assessment for intubation

Answer 2

1. Mouth opening >3cm
2. Jaw protrusion
3. Thyromental distance >6.5cm
4. Thyrosternal distance >12.5cm
5. Neck movements- Extn @ AO junction

When >1 of the above are abnormal- difficult intubation

Poor dentition, airway/ oral tmrs/ scarring/ infections, obesity- important factors that determine ease of intubation.

Modified Mallampati (Samsoon Young)
Grade 1.

Question 3

High cardiac risk