Preoperative Evaluation Flashcards
What is the preoperative history we would take in cases of emergency?
AMPLE
- Allergies
- Medications
- Past medical history
- Last meal
- Events leading up to problem
What are the areas of key information that we want to assess in a history for the preoperative evaluation?
- History of presenting illness
- Anesthetic history
- Review of systems
- Allergies
- Current medication
For the history of presenting illness for the preoperative evaluation, what do we want to ask about?
- Understand the reason for surgery
- The severity of the problem
- Any therapeutic interventions that
have been used
For the anesthetic history of the preoperative evaluatin, what do we want to ask about?
- Understand negative reactions to previous anesthetic
- Ask about FHx of negative reactions to previous anesthetic (e.g., malignant hyperthermia, plasma
cholinesterase deficiency)
For the review of systems history, what is the functional capacity?
o Functional capacity is a powerful predictor of postoperative cardiopulmonary and
neurocognitive complications. This is based on exercise tolerance.
How is functional capacity measured?
1 MET = consumption of 3.5 ml O2/kg/min
What is the value for poor exercise tolerance for functional capacity?
< 4 MET = poor exercise tolerance
What is MET 1 for functional capacity?
Eating, dressing
What is MET 2 for functional capacity?
Walking down stairs or in house
What is MET 3 for functional capacity?
Walking 1-2 blocks
What is MET 4 for functional capacity?
Raking leaves
What is MET 5 for functional capacity?
Climbing 1 flight of stairs
What is MET 6 for functional capacity?
Playing golf
What is MET 7 for functional capacity?
Playing tennis
What is MET 8 for functional capacity?
Slowly jogging
What is MET 9 for functional capacity?
Slowly jumping
What is MET 10 for functional capacity?
Briskly jogging
What is MET 11 for functional capacity?
Running for mild-moderate distances
What is MET 12 for functional capacity?
Running for moderate-long distances
What are the four conditions we want to ask about for the cardiovascular system review?
- CAD
- CHF
- Valvular disease
- Pacemaker/implantable cardioverter-defribillator
What does coronary artery disease (CAD) increase the risk for with anaesthesia? Who is this highest in risk for?
CAD increases the risk of perioperative myocardial ischemia or infarction; this risk is
highest in patients with a recent MI or UA
What do we have to ask for in treatment strategies in patients with a previous MI?
Patients with a coronary stent placed within the preceding year are at increased risk for perioperative MI
How long do we have to wait for a patient who has undergone an MI and wants to do elective surgery to receive anaesthetic?
Elective surgeries should not occur within 6 months of a MI
For patients with coronary artery disease, which medications should we continue and why?
Continue anti-anginal medications to maintain organ perfusion and decreased afterload
