pre op assessment Flashcards
When is the pre-assessment clinic before surgery?
It is two weeks before admission and usually FY1 lead
Which types of examinations are carried out in the pre-assessment clinic?
Cardiovascular examinations respiratory examinations
and examinations of the relevant system
What is ASA status?
It is how anaesthetists grade comorbidity
1= normal healthy individuals
2= mild systemic disease that does not limit activity
3= severe disease that is not incapacitating
4= severe disease that is a threat to life
5= moribund patient, not expected to survive 24hrs
What is the risk of having a pre-operative MI if you have already had one?
10-20% if MI <3/12 ago
1-2% if MI >6/12 ago
But long before surgery should a monoamine oxidase inhibitor be stopped?
Two weeks
Because it can cause hypertension with Anaesthesia
How long before surgery should an SSRI be stopped?
Three weeks
How long before surgery should an oral contraceptive be stopped?
Four weeks
How long before surgery should aspirin be stopped?
Seven days
How long before surgery should clopidogrel be stopped?
Five days
How long before surgery should warfarin be stopped?
Five days
And should you do a pre-operative ECG?
- For men over 40 and women over 50
- they are undergoing high risk surgery
- if they have more than one risk factor for coronary heart disease.
what blood tests should be done pre-operatively?
- full blood count
- urea and electrolytes
- coagulation screen
- glucose
- liver function tests in biliary / colorectal surgery
- calcium in thyroid surgery
- group and save / crossmatch
- TSH if hypo or hyperthyroid disease
what can be used to assess heart failure in pre-operative patients?
assess severity (NHYA class) I- no limitation II- ordinary activity leads to dyspnoea III- little activity leads to dyspnoea IV- dyspnoea at rest
echocardiogram
what are you unable to use in a patient with a pacemaker?
a medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot.
what should you give as a replacement for warfarin preoperatively?
- LMW heparin