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Surgery M4 part 1 > Preoperative assessment > Flashcards

Preoperative assessment Flashcards

1
Q

How do we consider a surgery as an emergency surgery?

A

if its life, limb, or organ saving

OPTIMAL TIMING <6hrs

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2
Q

When should an urgent surgery be preformed?

A

if there is any condition that threatens life, limb, or organ
OPTIMAL TIMING 6-24hrs

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3
Q

If a patient is stable, but requires intervention within the next couple of days or weeks, how do we categorize this surgery?

A

time-sensitive surgery

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4
Q

What are the surgeries that can take up to 1 year to preform?

A

elective surgeries

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5
Q

What are the systems that should be reviewed before anesthesia?

A

CNS
- GCS = 8 intubation has to be preformed to preserve airway but wait until it gets higher to take to OR
(GCS decreases 2 after patient wakes up)

CVS

  • all anesthesia drugs weaken the heart so patient with a weak heart may develop MI
  • if heart is transplanted
  • use regional anesthesia is heart is diseased

Liver Stat

  • drug metabolism
  • clotting factors

Lung Stat
- use regional anesthesia if lungs are diseases

Kidney
- drug clearance

Stomach

  • when was the last meal
  • gerd
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6
Q

What are the most important things to take from a patient’s history before anesthesia?

A
  • if patient had previous anesthesia and malignant hyperthermia
  • allergies
  • medications
  • difficult intubation
  • previous experience
  • delayed emergence/recovery
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7
Q

What are the drugs that may interfere with anesthesia?

A

HEART BRAIN
-heart failure - anticonvulsants
-antihypertensives - psychiatric medications
- antiarrhythmic
BLOOD
- anticoagulants
LUNG - antiplatelets
- bronchodilators

ENDROCRINE

  • steroids
  • insulin
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8
Q

What drugs should be stopped before surgery?

A

ANTICOAGULANTS

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9
Q

which drugs will be continued throughout surgery?

A

antihypertensives

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10
Q

Which drugs require a dose modification pre-op?

A

steroids need a stress dose to compensate body need during surgery

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11
Q

Which drugs should be changed?

A

Warfarin should be changed to heparin then stopped 4 hours pre-op

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12
Q

What physical examination should be preformed for the brain pre-op?

A
  • level of consciousness
  • any neurological deficit
    • paresthesia
    • paraplegia
    • peripheral nerve injury
  • position on operating table or surgical complication
  • GCS
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13
Q

What are the airway examination tests that should be preformed pre-op?

A
  • Mallampati’s test
  • Thyromental and sternomental distance (normal is
    1. 5cm)
      • less than 6cm is difficult
  • head extension (35 degrees or more is normal)
  • mouth opening
    - less than 4cm or 3 fingers is difficult
  • Cormack and Lehane view
    - Grade I: vocal cords visible
    - Grade II: only posterior commissure or arytenoids
    visible
    -Grade III: only epiglottis visible
    - Grade IV: no glottic structure visible
  • X-ray, CT, or MRI for lower airway if abnormality is suspected
  • Flexible nasendoscopy if there’s a suspected abnormality above vocal cords
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14
Q

What should be done in case of difficult intubation?

A
  • awake intubation
  • awake percutaneous tracheostomy under local anesthesia
  • postpone surgery
  • refer to a higher center
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15
Q

What symptoms could be found in case of heart problem during physical examination?

A

raised JVP

pitting edema

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16
Q

How do we assess the preioperative cardiac risk?

A

Metabolic equivalent task (MET): measure of functional capacity which estimates energy requirement for daily activities

17
Q

How many METS are required for surgery?

A

MINIMUM 4 METS

1 MET is 3.5mL/kg/min = resting oxygen uptake

18
Q

What are the blood tests required pre-op?

A
  • Haemoglobin (13 - 18 in males & 11.5 - 16.5 in females)
  • HCT (0.4 - 0.52)
  • Platelets (150-400)
  • WBCs (4-11)
  • Group and screen/crossmatch
    - ABO (10mins)
    - cross matching (45mins)
19
Q

What tests of coagulation should be made pre-op?

A
  • INR to monitor Warfarin therapy
  • APTT to monitor unfractioned heparin
  • TT to diagnose hypo/dysfibrinogenaemia
  • assess liver function
  • assess coagulopathy
20
Q

Why is the ECG used?

A

To assess cardiac rhythm and identify any pathology that may cause surgical risk

  • Q-wave = previous infarction
  • arrhythmia = conduction defects
  • bundle branch block = heart ischemia
  • strain patterns = hypertrophy of heart chambers (uncontrolled blood pressure)
21
Q

What is the most important lead to check pre-op?

A 
LEAD II (measures the same direction of conduction) 
most accurate
22
Q

What is the indication of an ECHO?

A

structural and functional assessment of heart and great vessels

STRUCTURE

  • size of chambers
  • wall motion
  • valves

FUNCTION

  • ejection fraction
  • pulmonary artery
  • aorta
  • valves
23
Q

What is the purpose of preoperative evaluation?

A
  • to identify patients whose conditions are too poor so surgery will only hasten their death
  • can lead anesthesiologist to change their anesthetic plan
  • to provide patient wit anesthetic risk
  • to provide psychological support
  • to obtain informed consent for the anesthetic plan
24
Q

Which classification is based ONLY on the patients medical disease NOT the surgical procedure?

A

American Society of Anesthesiologist’s classification ASA
1 normal
2 controlled systemic disease
3 uncontrolled systemic disease
4 severe systemic disease that is a constant threat to life
5 moribund patient who is not expected to survive without the surgery
6 brain dead patient whose organs are being removed for donor purposes

25
Q

what are the pre-operative fasting guidelines?

A
  • Clear liquids - 2 hours
  • breast milk - 4 hours
  • normal milk - 6 hours
  • light meal - 6 hours
  • heavy meal - 8 hours
  • medications - depends on their excretion
26
Q

Why should a proper preoperative evaluation always be done?

A 
It will guide the anesthetic plan
if it was inadequate it will lead to 
- avoidable delays 
- cancellations 
- complications 
- costs

Surgery M4 part 1 (47 decks)

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