Pre-operative Assessment

Question 1

Aims of Pre-operative assessment (5)

Answer 1

Contact with patient
Targeted Hx and exams & investigations
Assess risks of surgery vs current condition
Explain techniques and post-op analgesia to pt
Prescribe pre-medication & obtain consent

Question 2

Components of an assessment (5,5,1)

Answer 2

History - PC, PMH, Anaesthetic Hx, FHx, DHx,

Exam - General, Airway, Breathing, circulation, nervous system, systems review

Question 3

History for a pre-op assessment

Answer 3

Urgency of current condition
Co-existing medical problems
Drug Hx –> allergies, smoking/drinking etc
AHx –> any specific relvant disorders (pseudo-cholinesterase deficiency, porphyria, Myesthenia gravis)

Question 4

General Exam for a pre-op assessment (4)

Answer 4

Nutritional state
Fluid balance
Condition of skin/jaundice
Temperature and regulation

Question 5

Airway Exam for a pre-op assessment (3)

Answer 5

Mouth opening (Mallampati score)
Neck mobility
Quality of teeth and anything else in the oral cavity

Question 6

Respiratory Exam for a pre-op assessment

Answer 6

Is there any cyanosis, dyspnoea?
Are the lung fields clear? Pt in respiratory failure?
Any Hx of asthma, COPD,

Question 7

Circulatory Exam for a pre-op assessment

Answer 7

BP, peripheral pulses, JVP/oedema, heart sounds & murmurs
Is the patient in heart failure?
Assess risk of IHD, HTN, arrhythmia –> if concerned perform ECG, CXR, ABG

Question 8

CNS Exam for a pre-op assessment

Answer 8

Are there any dysfunctional nerves, reflexes or senses?
GCS (eye opening, verbal & motor response)
Confusion, epilepsy or head injury

Question 9

Metabolic & endocrine review pre-op assessment

Answer 9

Renal failure? (acute or chronic)
Liver disease? (effects on clotting or drug metabolism)
Diabetes (consider insulin infusion for IDDM or NIDDM if long op)
Thyroid and adrenal function

Question 10

Haematology review for pre-op assessment

Answer 10

Anaemia –> occult blood loss? sickle cell and other haemoglobinopathies, acute loss
Clotting disorders –> liver disease, anticoagulant therapy

Question 11

ASA classification (American society of anaesthetists)

Answer 11

I - normal healthy patient - 0.1% mortality
II - mild systemic disease - 0.2-0.7% mortality
III - activity limiting disease - 1.8-3.5% mortality
IV - incapacitating disease - 7.8-18.3% mortality
V - Moribund (dying) patient - 9.4-40% mortality
Add ‘E’ for emergency patient (x2)

Question 12

Goldman Index scoring factors

Answer 12

HF=11, Recent MI=10, ventricular ectopic=7, Dysrythmias=7, aortic stenosis=5, age >70=3, Emergency=4, poor condition=3,
thoracic or abdominal site of op=3
Max 53

Question 13

Modified Mallampati score

Answer 13

With the pt sitting how far can they open their mouth
I - soft palate, whole uvula and palantine arches
II - soft palate, uvula and anterior palantine arch
III - soft palate and base of uvula
IV - only hard palate visible

Question 14

Pre-op respiratory measures (5)

Answer 14

Bronchodilator therapy
Infection control/treatment
Physiotherapy and drainage of secretions,
Tapping of any effusions
Controlled oxygen therapy

Question 15

Major pre-op cardiac risk factors (5)

Answer 15

Heart failure
Recent MI (5 premature ventricular ectopics/min or dysthymias
Aortic stenosis

Question 16

Pre-op cardiac measures (3)

Answer 16

For heart failure –> vasodilators, diuretics, inotropes,
Dysrythmias need drugs or emergency pacing
VTE prophylaxis & Fluid control

Question 17

Patients at risk of respiratory complications (4)

Answer 17

Smokers
Those with pre-existing lung disease
Obese
Upper abdominal or thoracic surgery

Question 18

Goldman Index operative risks of major complications

Answer 18

0-5 points= 0.3-3% risk
6-12 points= 1-10% risk
13-25 points= 3-30% risk
26-53 points= 19-75% risk

Question 19

Cormak-Lehane classification

Answer 19

A more formal classification of intubation difficulty based on what can actually be seen during intubation

Question 20

AMPLE History

Answer 20

Allergies
Medications
Past medical history
Last eating and drinking
Everything else