Pre-op management





History taking

    1. Anaesthetic history: personal and familial
    2. Previous airway/ intubation difficulties
    3. Medication: current and past
    4. Allergies and previous drug reactions
    5. Previous anaesthetic exposure and surgery
    6. Respiratory status and symptoms (especially asthma and COPD)
    7. Cardiovascular status and symptoms (especially IHD and hypertension)
    8. Neurological status and symptoms (especially epilepsy, CVAs, conscious level and including mental state)
    9. Gastro-intestinal problems (especially reflux, obstruction, potentially delayed gastric emptying)
    10. Arthropathies and other musculo-skeletal problems (especially rheumatoid arthritis)
    11. Renal conditions
    12. Hepatic conditions (especially jaundice, cirrhosis)
    13. Endocrine conditions (especially diabetes, steroid therapy)
    14. Skin conditions
    15. Obstetric conditions
    16. Congenital disorders affecting anaesthesia
    17. Hereditary disorders affecting anaesthesia
    18. Haemoglobinopathies
    19. Coagulopathies
    20. Nutritional abnormalities (especially obesity)
    21. Social problems and identification of high risk groups for infection

 

Physical Examination

    1. Teeth/ airway/ cervical spine/ intubation assessment
    2. Cardiovascular system (IHD, hypertension, LVF)
    3. Respiratory system (asthma, COPD)
    4. Nutritional state (obesity)
    5. Neurological system (GCS: any acute or residual effects of CVA)
    6. Abdomen and GI tract
    7. Anaemia
    8. Jaundice
    9. Sequelae of diabetes and steroids
    10. Musculo-skeletal problems (including relevance to positioning, neck stability, regional blockade)

Implications for anaesthesia of co-morbidity and special physiological conditions

Implications for anaesthesia of procedure

Guidelines for fasting and smoking

Thromboprophylaxis

Planning postoperative analgesia

Planning postoperative strategy for PONV

Assessing need for HDU or ICU postoperatively

Assessing need for senior advice or assistance.

Ensuring the necessary resources are available for safe patient care

The Consent process including paediatrics and understanding the problems of obtaining consent in patients with impaired consciousness.

Other issues of patient communication

    1. Explanation of need for preoperative routine and specialised tests (including hepatitis screening, HIV testing and sickle cell status)
    2. Explanation of pain management, side effects and complications of: oral/sublingual/rectal/subcutaneous/IM/IV/nasal/transdermal drugs
    3. Epidural/regional techniques/local blocks
    4. Inhalational analgesia
    5. Patient controlled analgesia
    6. Discussion of preoperative medication choices
    7. Explanation of postoperative expectations and care, including common and important complications

Communication with other professionals

Dangers of repeat anaesthesia

Premedication

    1. Rationale for use of premedicant drugs
    2. Choice of drugs, advantages and disadvantages
    3. Understanding of causes of delayed gastric emptying
    4. Rationale for antacid, and prokinetic premedication
    5. Rationale for antithrombotic therapy

Anaesthetic pre-assessment clinics

CEACCP 2006: DECEMBER
D M Levy
Pre-operative fasting—60 years on from Mendelson

CEACCP 2006: AUGUST
Craig Oranmore-Brown and Richard Griffiths
Anticoagulants and the perioperative period