PREOPERATIVE ASSESSMENT (anaesthesia)2024.pptx

Preoperative assessment

1. PREOPERATIVE ASSESSMENT & PREPARATION WILLIAM ADDISON NURSING/MIDWIFERY 2024 Slide 1

2. OBJECTIVE Why the need for preoperative assessment How to perform a simple preoperative anaesthetic assessment Categorize patient’s risk of anaesthesia and surgery Slide 2

3. Establish rapport Evaluate patient’s overall health status Anticipation of possible complications Confirm anticipated benefits outweigh risks Ensure optimization of patient condition Plan anaesthetic technique Adequate preparation both logistics & personnel Patient education & consent Premedication Slide 3 AIM

4. Confirm identity, type, site & duration of surgery Past anaesthetic Hx Type, when Complications: Delayed recovery, PONV, difficult intubation, etc Chronic illness Family Slide 4 HISTORY

5. DRUGS: Allergy Social: smoking, alcohol, illicit drugs Organ damage Withdrawal symptoms Dose of anaesthetic Slide 5

6. General CVS Respiratory Airway Nervous Others Slide 6 EXAMINATION

7. Hx Thick short neck Stiffness of cervical spine Limited mouth opening Growth in the oropharynx, airway Neck mass Receding chin deviation of the trachea Mallampati score III, IV Slide 7 AIRWAY ASSESSMENT

8. Slide 8 Mallampati Score

9. FBC HB electrophoresis Urine urea, creatinine , electrolytes Liver Function test Coagulation profile Radiological ECG: known cardiovascular risk OTHERS: Slide 9 INVESTIGATIONS

10. ASA DEFINITION EXAMPLES ASAI Healthy patient Healthy, non-smoking, no or minimal alcohol ASA II Patient with mild systemic disease Current smoker, social alcohol drinker, obesity (<40), well-controlled HPT/DM, normal pregnancy, controlled PIH ASA III Patient with severe systemic disease MI, CVA (>3months), alcohol dependence, poorly controlled HPT/DM, BMI≥40, ESKD on regular scheduled dialysis, Pre-eclampsia, premature neonate, term infant less than 6wks, difficult airway Slide 10 ASA CLASSIFICATION

11. ASA DEFINITION EXAMPLES ASAIV A patient with severe systemic disease that is a constant threat to life Recent (<3months) MI, CVA, ESKD not on regular dialysis, sepsis, DIC, Pre-eclampsia complicated by HELLP syndrome or eclampsia, shock, DIC, severe respiratory distress, advanced oncologic state ASA V A moribund patient who is not expected to survive 24h without surgery Ruptured thoracic/abdominal aneurysm, massive trauma, intracranial bleed with mass effect, ischaemic bowel disease with cardiac pathology or multiple organ dysfunction Uterine rupture ASA VI Brain stem dead patient whose organs are being removed for donor purposes Add E to denote emergency eg ASA IIE Slide 11 ASA CLASSIFICATION

12. Fitness for anaesthesia depends on a lot of factors including urgency of surgery. Final decision between surgeon, anaesthetist  & the patient Acute Upper airway Infection Uncontrolled co-morbidity Inadequate resuscitation Recent Ingestion of food drugs consent Slide 12 POSTPONING SURGERY

13. Personnel Space Equipment Drugs consent Slide 13 PREPARATION

14. Minimum fast period Clear Fluids : 2hours Breastmilk : 4hrs Solid food, non-human milk:6hrs Factors affecting gastric emptying Raised intra-abdominal pressure, DM, Pregnancy Slide 14 FASTING GUIDELINES

15. Adm of drugs 1-2hrs before induction allay anxiety and fear reduce postoperative nausea and vomiting reduce gastric volume and increase the pH of gastric contents Others: against specific conditions Slide 15 PREMEDICATION

16. THANK YOU Slide 16