PreOp Assessment Flashcards

(72 cards)

1
Q

What are the 3 steps to pre op assessment

A

History
Examination
Investigation

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2
Q

List 6 important components of the preop hx

A
  • age and gender
  • indication for surgery
  • surgical/anesthetic surgery
  • familial hx
  • medications & allergies
  • past medical hx
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3
Q

What aspect of the past surgical/Anesthetic hx is important?

A
  • past intubation
  • PONV
  • anaesthesia complications
  • previous anaesthetics
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4
Q

What details are important in the family hx

A
  • anaesthetic reactions
  • MH (malignant hyperthermia)
  • pseudocholinesterase deficiency
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5
Q

It is good to ask system based medical histories. What are you looking for in your Neuro hx?

A

TIA/Strokes
Raised ICP
Spinal Disease
Aneurysm
NMJ problems

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6
Q

It is good to ask system based medical histories. What are you looking for in your CVS hx?

A

angina/cad
MI
CHF
HTN
Valvular disease
Dysrythmias
PVD

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7
Q

It is good to ask system based medical histories. What are you looking for in your Respi hx?

A

Smoking
Asthma
COPD
URTI
apnea

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8
Q

It is good to ask system based medical histories. What are you looking for in your GI hx?

A

GERD
Liver disease
NPO status

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9
Q

It is good to ask system based medical histories. What are you looking for in your Renal hx?

A

Chronic Renal Failure
Dialysis

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10
Q

It is good to ask system based medical histories. What are you looking for in your MSK hx?

A

Arthralgia
Cervical spinal pathology
Cervical spine instability

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11
Q

It is good to ask system based medical histories. What are you looking for in your Endocrine hx?

A

DM
Thyroid disorders
Adrenal Disorders

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12
Q

It is good to ask system based medical histories. List some other important information not mentioned in the previous systems?

A

Pregnancy
Ethanol/ recreational drug use
Morbid obesity

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13
Q

List 8 aspects of the physical exam for pre op anaes

A
  • weight, height, BP, HR, RR, O2 sat
  • CNS, CVS, RESPI
  • assess nutrition, hydration, mental status
  • Airway assessment & Ventilation
  • Tongue size
  • Dentition, Dental appliances/ prosthetic caps, chipped/teeth
  • Nasal passage latency
  • examination of anatomical sites relevant to lines and blocks
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14
Q

How do you evaluate a difficult airway?

A

L - look (obesity, facial/dental Abn. beard, neck)
E - evaluate 3,3,2 rule
M- Mallampati score
O- Obstruction
N- Neck mobility

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15
Q

How do you assess difficult ventilation anesthesia ?

A

BONES
B- beard
O- obesity
N- no teeth
E- elderly (>55)
S- Snoring hx (sleep apnea)

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16
Q

What is the 3-3-2 rule?

A

1) 3 of the patients own finger can be placed between incisors
2) 3 fingers along the floor of the mandible (between mentum and hyoid)
3) 2 fingers in the superior laryngeal notch (thyroid- mouth distance)

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17
Q

Full view of uvula (body and base of uvula) and Tonsillar pillars describes what Mallampati Score?

A

1

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18
Q

View of the body and base of the uvula, with partial view of the tonsillar pillars describes what Mallampati score

A

II

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19
Q

View of the base of the uvula is described as what Mallampati score

A

III

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20
Q

View of the hard palate with no other visible structures is described as what Mallampati score

A

IV

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21
Q

What grading system is used for Laryngeal View?

A

Cormack- Lehane Classification

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22
Q

Describe Grade 1 Cormack- Lehane Classification

A

All Laryngeal structures revealed

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23
Q

Describe Grade 2A Cormack- Lehane

A

Partial view of the glottis

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24
Q

Describe Grade 2B Cormack- Lehane

A

Only the arytenoids visible

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25
Describe Grade 3 Cormack- Lehane
Larynx is concealed only epiglottis seen
26
Describe Grade 4 Cormack- Lehane
Neither epiglottis nor glottis seen
27
What are three other scoring systems used to assess difficult airways
Thyromental distance Calder test Wilson Score
28
List 5 factors of the Wilson Score System
(Wilson Understands Joy Ride Baking) Weight Upper cervical spine mobility Jaw movement Receding mandible Buck teeth
29
Describe the ASA classification system perioperative clinicians a simple categorization of a patient's physiological status that can help predict operative risk.
I A normal healthy patient II A patient with mild systemic disease III A patient with severe systemic disease IV A patient with severe systemic disease that is a constant threat to life V A moribund patient who is not expected to survive sans surgical procedure VI A declared brain dead patient whose organs are being removed for donor purposes The addition of E indicates emergency surgery
30
Which patient counts as a high risk patient
Those who must be seen by an anesthesiologist in their pre operative clinic
31
Which patients are usually seen by anaesthesthetists in clinic
Patients at or above ASA 3 Prior or anticipated difficulties with anaesthesia Patients having complex procedures performed
32
What is the target BP reading that you should aim for when dealing with hypertensive patients in anesthesia
<180mmHg SBP and <110mmHg DBP
33
Which antihypertensives should be avoided on the day of surgery and why
Ace inhibitors and ARBs Due to the increased risk of refractory hypotension
34
How long should a post MI patient wait before surgery
60 days
35
What is the glycaemic target in critical patients with DM
<10 mmol/L
36
What is the glycaemic target in stable patients with DM
<7.8 mmol/L
37
True or False Oral anti diabetic medications should be given on the day of surgery
False
38
Why are URTI and poorly controlled asthma absolute contraindications for Anaesthesia
It can increase the risk of bronchospasm
39
What is the minimum time that you can have a heavy meal before surgery?
8hrs
40
What is the minimum time that you can have a light meal/ cow’s milk/ infant formula before surgery?
6hrs
41
What is the minimum time that you can have breast milk before surgery?
4hrs
42
What is the minimum time that you can have non-alcoholic clear fluids before surgery?
2hrs
43
What are the benefits of allowing clear liquids up to 2hours pre-op?
Less patient thirst and hunger Lower risk of aspiration
44
Define premedication
The administration of medication before a treatment or procedure
45
What are the 6 A’s of premedication?
Anxiolysis Amnesia Antiemetic Antacid Anti- autonomic Analgesia
46
Which drug class is administered for anxiolysis and when?
Benzodiazepines (45-90mins before)
47
Which drug class is administered to induce amnesia?
Benzodiazepines
48
What is the Moa of benzodiazepines
Benzodiazepines facilitate the binding of inhibitory neurotransmitter GABA at various GABA receptors in the CNS GABA functions to reduce neuronal excitability by inhibiting nerve transmission
49
Benzodiazepines can be classified as long acting, intermediate acting and short acting List an example of each
LA: Diazepam (Valium) 1-3 days SA: Midazolam (Versed) 3-8 hrs IA: Alprazolam (Xanax)/ Lorazepam (Ativan) 11-20hrs
50
Which drug classes can be administered as antiemetics ?
5-HT antagonist Dopamine Antagonist Antihistaminic Anticholinergic
51
Describe the moa of 5-HT antagonists (selective serotonin antagonists) as antiemetics
Vomiting is controlled by the vomiting center in the brain, which is activated by triggers such as strong smell, thoughts and motion. The cells that line the gastrointestinal tract release serotonin (a chemical messenger responsible for transmitting vomiting signals) when they are damaged. This serotonin binds to the serotonin receptors present on the nerves that transmit impulses to the vomiting center located in the brain, which in turn activates the vomit reflex. Antiemetic 5-HT3 antagonists block the serotonin both peripherally, on gastrointestinal vagal nerve terminals, and centrally in the chemoreceptor trigger zone; this blockade results in powerful antiemetic effects.
52
How do Antihistaminic agents function as antiemetics?
Histamine is a key molecule for transmitting stimuli from the inner ear to the brain during vomiting due to motion sickness They block H1 receptors
53
What neurotransmitters are involved in vomiting?
acetylcholine, dopamine, histamine (H1 receptor), serotonin (5-HT3 receptor)
54
List 1 Dopamine antagonist
Metoclopromide (Reglan)
55
List 1 selective serotonin antagonist
Ondansetron
56
List 1 Antihistaminic drug
Diphenhydramine (Benadryl)
57
List 3 antacid drug classes used
H2 Blocker PPI Sodium citrate
58
Describe the moa of H2 blockers
H2RAs decrease gastric acid secretion by reversibly binding to histamine H2 receptors located on gastric parietal cells, thereby inhibiting the binding and activity of the endogenous ligand histamine.
59
Give one example of an h2 blocker
RANITIDINE Famotidine
60
Describe the moa of PPI
Ultimately, PPIs function to decrease acid secretion in the stomach. The proximal small bowel absorbs these drugs, and once in circulation, affect the parietal cells of the stomach. The parietal cells contain the H+/K+ ATPase enzyme, the proton pump, that PPIs block. This enzyme serves as the final step of acid secretion into the stomach
61
List some PPIs
Omeprazole Esomeprazole Pantaprazole
62
How does sodium citrate act as an antacid
It acts by neutralizing acid in the stomach and urine, raising the pH
63
List two groups of Antiautonomic drugs
Anticholinergics Beta Blockers
64
List 2 groups of Anticholinergic drugs
Antisialogogue Antivagolytic
65
List some Anticholinergic d’agents
Atropine IV/IM/SC Glycopyrrolate - 4mcg/kg IM
66
List some Analgesics
Opioids - Morphine - fentanyl
67
List 5 contraindications to anaesthesia
No consent Allergy Hypersensitivity Respiratory Depression Cardiovascular Issue Liver or Kidney Dysfunction Pregnancy and Breastfeeding
68
PACU (Post Anaesthesia Care Unit) What is post anaesthesia care?
Steps taken after the completion of a surgical procedure to manage a patient who has received general anaesthesia or sedation
69
What are the 4 goals of Post Anesthesia Care
To reduce postoperative adverse events To provide a uniform assessment of recovery To improve post anaesthetics quality of life To streamline postoperative care and discharge criteria
70
What are 4 reasons that patients should be given oxygen in the postoperative period?
To counter effects of diffusion hypoxia when nitrous oxide is used Compensate for hypoventilation Compensate for V/Q mismatch Meet the increased oxygen demand when shivering
71
List 2 techniques of administration of postoperative analgesia
Patient Controlled Analgesia (PCA) Regional Analgesics Technique (nerve block, epidural analgesia)
72
List 8 criteria for discharge of patients from the post anaesthesia care unit
Fully conscious - able to maintain airway CVS stable Pain and PONV controlled Temperature acceptable IV Cannulae patent (flushed to remove residual anaesthesia) All surgical drains and catheters checked All health records and medical notes completed