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8 Cards in this Set
- Front
- Back
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As part of the pre-operative assessment, the most important thing to assess in the patient is their exercise tolerance, what is the name of the scoring system used to measure the exercise tolerance of the patient? |
Patients exercise tolerance is rated before surgery using METS scoring system. Patients are asked what actives they can perform before they become breathless. If they get breathless when simply walking around the house = 2 METS If it takes strenuous exercise to make the breathless then score = 9 METS The lower the METS score - the worse their exercise tolerance and thus they are much higher risk. *IF SCORE LESS THAN 5 METS THEN MAY NOT BE ABLE TO WITHSTAND ANAESTHETICS* |
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What parts of the body are assessed pre-operatively which could flag up potential anaesthetic problems? |
Difficult airway - look in mouth and at neck for potential airway access issues Spine - Scoliosis? - May make epidural difficult Reflux - is there any acid reflux issues which could come up into lungs and cause aspiration. Often patients given Omeprazole before surgery. Family history - Malignant hyperperplexia – conditon triggered by anaesthetic,causes temp rise, tachy ect. Also look for Cholinesterase deficiency - need to modify drugs given if so. |
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What is the name of the grading system used to determine the risk of complications occurring in a patient under anaesthetic? |
ASA - American society of Anaesthology (used in America to work out insurance rates) Goes from 1-6, 1= healthy patient, 6 = organ retrieval dangerous surgery |
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What is the issue with the accuracy of the ASA scoring system for determining risk of anaesthetic? |
It doesn't take into account smokers or morbidly obese patients. They could have a BMI of 50 but still get an ASA score of 1. |
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Another system used to calculate the patients anaesthetic risk is the 'Cardiac Risk Index', what diseases taken into account to calculate the CRI? *considered better than the ASA system* |
Ischaemic Heart disease Congestive heart failure Cerebrovascular disease Diabetes Renal Failure *get a tick for every one you have, the higher the score the higher the risk* |
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What factors need to be taken into account before subjecting a patient to loads of cardio and respiratory investigations before surgery? |
Needs to be justified - do the risks of the investigation outweigh the benefits and impact it will have on the management of surgery? Target only those at risk Sensitivity and specificity of the test |
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What are the three medications where it is essential they continue as normal before surgery? |
Inhalers Anti-anginals Anti-epileptics |
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Most medications continue before surgery, what are the two exceptions to this rule? |
Anti-coagulants & Diabetic medication have to be stopped! If a diabetic patient is coming in for a day case they will always be first to be seen, so they can be done quickly then have breakfast. If they are coming for lengthy surgery, give insulin and glucose IV. The only exception to stopping anti-coagulants is if they have recently had a stent fitted. Stopping the anti-coagulants could cause a massive MI. |
