Pre-op Assessment

Question 1

What are examples of traumas of surgery the body endures?

Answer 1

• Includes:
  • Stress response
  • Fluid shifts
  • Blood loss
  • Cardiovascular, respiratory, renal and metabolic stress

We give the patient anaesthesia:

• GA
  
  • Drug induced reversible coma
  • CNS, cardiac and respiratory depression
  • Drug interaction
• Regional anaesthesia
  
  • Profound sympathectomy
  • Neurological sequalae

Question 2

What needs to be considered in the pre-op assessment?

Answer 2

• Patient
  
  • Known co-morbidities
  • Unknown pathologies
• Nature of surgery
• Anaesthetic techniques
• Post-op care

Question 3

Describe the anaethetists role pre-op?

Answer 3

Includes:

• Assess
• Identify high risk
• Optimise
• Minimise risk
• Inform and support patients decisions
• Consent

What we can do depends on what time available:

• Could be planned elective surgery, urgent surgery or emergency surgery

Question 4

What is the purpose of the pre-op assessment?

Answer 4

Purpose of pre-op assessment is for optimisation to reduce risks in surgery:

• Optimal medical control
  
  • Most medications continue as normal, especially inhalers, anti-anginals and anti-epileptics
  • Exceptions are possibly anti-diabetic medication and anticoagulants
• Optimal lifestyle
  
  • Smoking, alcohol, obesity, exercise

Question 5

What medications must continue as normal before an operation and what usually dont?

Answer 5

• Most medications continue as normal, especially inhalers, anti-anginals and anti-epileptics
• Exceptions are possibly anti-diabetic medication and anticoagulants

Question 6

What are important lifestyle factors that are assessed pre-op?

Answer 6

• Smoking, alcohol, obesity, exercise

Question 7

What are the different aspects of the pre-op assessment?

Answer 7

• History
• Examination
• Investigations

Question 8

What are important aspects of the history pre-op?

Answer 8

• Known co-morbidities – severity, control
• Unknown co-morbidities – systemic enquiry, clinical examination
• Ability to withstand stress – exercise tolerance, reason for limitation, carido-respiratory disease
• Drugs and allergies
• Previous surgery and anaesthesia
• Potential anaesthetic problems – airway, spine, reflux, obesity, family history

Question 9

What investigations are done in the pre-op assessment?

Answer 9

Particularly interested in CVS and respiratory system

Question 10

What is considered when choosing which investigations to do pre-op?

Answer 10

• Sensitivity and specificity
• Target those at risk
• Iatrogenic harm of over-investigation
• NICE guidelines – ASA grade, surgery grade, co-morbidities

Question 11

Describe ASA grading?

Answer 11

Question 12

Other than ASA grading, what are some other risk assessment tools?

Answer 12

• Other risk assessment tools: POSSUM scores, STOP-BANG questionnaire, GUPTA perioperative cardiac risk, cardiac risk index (used often, 1 point for each condition where 2 or more points means most at risk)

Question 13

Describe the cardiac risk index?

Answer 13

1 point for each condition where 2 or more points means at risk

Question 14

Describe exerice tolerance (METS)?

Answer 14