Pre-Operative Assessment

Question 1

Why is a pre-op done?

Answer 1

1. Medicolegal for consent
2. Identify chronic disease and risk factors
3. Identify areas for optimisation + balance risk
4. Formulate the appropriate anaesthetic care plan

Question 2

5 aims of the pre-op visit

Answer 2

1. formulate appropriate plan for patient and procedure
2. understand the pt baseline physiological state
3. identify risk factors
4. identify areas for optimisation
5. prep pt psychologically

Question 3

Patient considerations pre-op

Answer 3

• consent and documents
• full medical hx
• allergies and medications
• examination
• airway assessment
• prior issues with surgery or anaesthesia

Question 4

elective surgery pre-op

Answer 4

patient is seen day before or morning of

Question 5

urgent and emergency pre-op

Answer 5

seen in induction room

Question 6

critically ill pre-op

Answer 6

little time to assess

Question 7

4 procedural considerations

Answer 7

1. is it elective or urgent ?
2. type of procedure: superficial or deep, duration, estimated blood loss
3. location
4. positioning

Question 8

Pertinent history needed

Answer 8

• current issue
• co morbidities
• meds
• prior anaesthesia
• relevant family hx
• systematic review
• last oral intake

Question 9

fasting period for solids and formula milk

Answer 9

6 hrs

Question 10

fasting period for breast milk

Answer 10

4 hrs

Question 11

fasting period for clear fluids

Answer 11

2 hrs

Question 12

what else can be asked regarding oral intake?

Answer 12

last meal

last injury / trauma

risk factors for a full stomach

Question 13

what are the risk factors for aspiration?

Answer 13

> unfasted
pregnancy
gastric pathology
renal failure
increased abdominal pressure
autonomic neuropathy in diabetics

Question 14

Special investigations pre-op

Answer 14

Should be guided by patients age, comorbidity and planned procedure:

• FBC
• U&E (e.g. hypertension / renal disease / elderly / acutely ill)
• Group and Save / Crossmatch (e.g. major blood loss)
• ECG (e.g. elderly / cardiac pathology / hypertension / ischaemic heart disease)
• CXR (e.g. respiratory and cardiovascular disease, elderly)
  Echocardiography (e.g. valve lesions / cardiac disease_

Question 15

ASA I

Answer 15

Normal healthy pt

Question 16

ASA II

Answer 16

mild systemic disease and no functional limitations

Question 17

ASA III

Answer 17

moderate to severe systemic disease that results in some functional limitation, but not incapacitating

Question 18

ASA IV

Answer 18

severe systemic disease that is a constant threat to life and incapacitating

Question 19

ASA V

Answer 19

Moribund that is not expected to live more than 24 hrs with or without the surgery

Question 20

ASA VI

Answer 20

Brain dead + organs being harvested

Question 21

E

Answer 21

emergency