Pre-Op Management Flashcards
(32 cards)
What is an ASA score?
A score for how risky a patient is to undergo an operation
What defines ASA 1?
Normal, healthy patient
What defines ASA 2?
Mild systemic disease
- One medication
- Well controlled and only few attacks (Asthma/COPD)
Includes Obesity, Smokers, Drinkers
What defines ASA 3?
Severe systemic disease
- Poor Control
- Limiting
- Lots of medications
Dialysis Patients
What defines ASA 4?
Someone with life-threatening systemic disease
What defines ASA 5?
Not expected to survive but would die otherwise
What defines ASA 6?
Brainstem dead patient
What tests do anesthetists do to assess intubation difficulty?
Mallampati
Thyromental distance (>3cm)
Neck movement
Jaw opening
What are the levels for mallampati?
1 - fully visible tonsils
2- partial
3 - only hard and soft palate
4 - only hard palate
What tests do you give routinely for a major Op to a ASA 1?
FBCs
U&Es/eGFR if risk of AKI
(ECG if over 65 and not had within 12 months)
What tests do you give routinely for a major Op to a ASA 2?
FBC
Kidney Function
ECG
What tests do you give routinely for a major Op to a ASA 3+?
FBC U&Es eGFR ECG Haemostasis Lung Function Test
What other investigations might you offer pre-op?
Urine Dip - diabetes, UTI, pregnancy
Echo - if murmur or heart failure
Liver Function
CXR - infection
Glucose
What basic tests would you always do?
Height Weight Pulse Check recent bloods MRSA swab
What HbA1c do you want for surgery?
<7.5 ideally
NEVER more than 8.5
What makes up the haematological assessment?
Hx of Bleeding or FHx of disorders
FBC - thrombocytopenic, platelet count, immune function, anaemia (can they carry as much O2? anaemics bleed more and have longer recovery)
Group and Save
Crossmatch
Sickle Cell Testing
What allergies are important to ask about?
Egg and Soya - propofol
Medications/Antibiotics/Penicillin
Latex
Suxamethonium Apnoea
Malignant Hyperthermia
How do you manage Latex allergies around surgery?
Have their own room
1st on the list
All latex is taken out the night before
Non-latex gloves are worn
Religious?
Jehovah’s Witnesses and Blood transfusion
Why ask about GORD?
As they may need a rapid sequence intubation
Risk of aspiration pneumonia
What do you ask someone with asthma?
Why is asthma important to remember?
Can they have NSAIDs?
How well controlled?
Higher risk of pneumothorax and bullae formation, bronchospasm
Why is renal/liver function important?
Drug Excretion
May need to lower the dose
- risk of overdoing it
Contrast may be used
Clotting Factors may be reduced
Hypermetabolism!
How do you manage diabetics peri-operatively?
1st on list
If they miss one meal then sliding scale insulin in operation
Which medications do you stop and when?
Clopidogrel - 7 days
Hypoglycaemic Agents on the day of surgery
Oral Contraceptive Pill - 28 days before and cover with alternative (also HRT)
Warfarin - 5 days before (INR needs to be under 1.5)
