Anesthesiology - Preoperative Assessment And Management

Front 1

What do you want to ask about the patient's endocrine system during pre-op assessment?

Back 1

Diabetes, thyroid

Front 2

What do you want to ask about the patient's nervous system during pre-op assessment?

Back 2

MS
Stroke
Spinal cord problems

Front 3

What do you want to ask about the patient's MSK system during pre-op assessment?

Back 3

Arthritis

Front 4

What are the elements of a thorough anesthesia history?

Back 4

What is this person having surgery for?

Are there co-morbidities impacting anesthetic planning?

Is the patient stable and optimized for surgery?

Is here a past or family history of anesthetic problems.

Review medications and allergies

Review NPO status

Front 5

What do you want to ask about the patient's cardiovascular system during pre-op assessment?

Back 5

Heart:
1) Exercise tolerance: ability to walk a couple of blocks, climb a flight of stairs

2) Pre-existing problems
-ischemic heart disease (angina, MI, stroke)

3) Current symptoms

Front 6

What do you want to ask about the patient's respiratory system during pre-op assessment?

Back 6

1) Pre-existing conditions:
-COPD
-Asthma
-Recent infections

2) Smoking history

Front 7

What do you want to ask about the patient's renal system during pre-op assessment?

Back 7

1) Do they have renal failure or kidney disease of any kind

Front 8

What do you want to ask about the patient's GI system during pre-op assessment?

Back 8

GI reflux
Hepatic disease

Front 9

What do you want to ask about the patient's hematologic system during pre-op assessment?

Back 9

Coagulopathy, hemoglobinopathy

Easy bruising, bleeding or clotting

Front 10

Describe the elements of the physical exam during pre-operative assessment.

Back 10

Vital signs

Mouth opening
-at least 2-3 fingerbreadths

Dentition
-capped or loose?
-prominent teeth?

Mallampati score

Thyromental distance
-three fingerbreadths

ROM of the neck
-90-165 degrees

Respiratory exam
-Air entry, adventitious sounds

Cardiac exam

Fluid status

Front 11

How much is normal range of motion of the next?

Back 11

90-165 degrees

Front 12

Which investigations do you want to order pre-operatively?

Back 12

Depends on patient and operation you're doing.

CBC, cross match for aortic aneurysm repair

Fasting blood sugar for diabetic

INR/PTT for patient on anticoagulatns

ECG for history of angina

CXR for recent fever/productive cough

Front 13

To whom would you assign an ASA score of 1?

Back 13

Healthy patient, no systemic disease

Front 14

What ASA score would you assign to a healthy patient with no systemic disease?

Back 14

ASA 1

Front 15

To whom would you assign an ASA score of 2?

Back 15

Patient with systemic disease present but no functional limitations

(e.g. controlled hypertension)

Front 16

To whom would you assign an ASA score of 3?

Back 16

A patient with systemic disease and definite functional limitations

Front 17

What ASA score would you assign to a patient with systemic disease but no resulting functional limitations?

Back 17

2

Front 18

What ASA score would you assign to a healthy patient with systemic disease and resulting functional limitations?

Back 18

3

Front 19

To whom would you assign an ASA score of 4

Back 19

Patient with severe systemic disease that represents a constant threat to life.

Front 20

To whom would you assign an ASA score of 5?

Back 20

Patient who is moribund, not expected to survive next 24 hours without surgery.

Front 21

To whom would you assign an ASA score of 6?

Back 21

Organ donor

Front 22

What ASA score would you assign to an organ donor?

Back 22

ASA 6

Front 23

What ASA score would you assign to a patient who is moribund and not expected to survive the next 24 hours without surgery?

Back 23

ASA 5

Front 24

Pre-operative orders

Back 24

NPO instructions

IV fluid type and rate

Preoperative medications

Aspiration prophylaxis

Antibiotic/steroid coverage

Anxiolytics

Front 25

What is the minimum duration of fasting for elective procedures...

After a meal/formula?

After breast milk?

After clear fluids?

Back 25

6 hours after meal or formula

4 hours after breast milk

2 hours after clear fluids

Front 26

What is the purpose of fasting before an operation?

Back 26

Decrease the risk of gastric aspiration

Front 27

For whom should you order a pre-op ECG as the anesthesiologist?

Back 27

Patients with known cardiac disease

Patients who have risk factors for cardiac disease, including age.

What are the risk factors?

Front 28

For whom should you order a pre-op chest X-ray?

Back 28

Patients with respiratory symptoms and recent fever (to rule out pneumonia)

Front 29

Why is a stomach never truly empty, even after NPO status?

Back 29

Gastric, biliary, and pancreatic secretions can still be present to variable degrees

Front 30

Should patients receive their normal medications pre-operatively.

Back 30

Yes, with the exception of monoamine oxidase inhibitors, anticoagulants, and platelet inhibitors.

Front 31

Name 5 classes of medications that are potentially given pre-operatively.

Back 31

Anxiolytics
Antibiotics
Anti-emetics
Bronchodilators
Anti-anginals
Anxiolytics

Front 32

What is meant by "aspiration prophylaxis"?

Back 32

1) Reduction of gastric acid secretion via anti-secretory agents (e.g. ranitidine)

2) Promotion of gastric emptying (e.g. metoclopramide)

Front 33

What is the mechanism of action of ranitidine?

Back 33

H2 receptor antagonist

Front 34

What is metoclopramide used for?

What is the mechanism of action?

Back 34

Reduce nausea, increase gastric emptying

Metoclopramide is a dopamine receptor antagonist.

Front 35

Which 5 monitors are required for each patient by the Canadian Anesthesia Society

Back 35

Pulse oximeter

Device to monitor blood pressure

ECG

Agent-specific anesthetic gas monitor when inhalation anesthetics are used

Capnography when ETT or LMA is in use