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Preoperative Assessment

Preoperative Assessment. Tutorial 1:. Vignette (1) & Question. A young woman is admitted to the surgical ward with a newly diagnosed breast lump. She is scheduled for an elective breast biopsy. She is visited before her surgery by the anaesthetist. What are the main purposes of his visit?

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Preoperative Assessment

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  1. Preoperative Assessment Tutorial 1:

  2. Vignette (1) & Question. • A young woman is admitted to the surgical ward with a newly diagnosed breast lump. She is scheduled for an elective breast biopsy. She is visited before her surgery by the anaesthetist. • What are the main purposes of his visit? • (Give 5 reasons)

  3. Answers. • Assess the patient’s state of health (fitness) • Identify potential problems • Plan the anaesthetic, including post op, care • Discuss important issues with the patient • Prepare the patient for anaesthesia

  4. Vignettes (2) & Question. • A 40-year old man has a prolapsed lumbar vertebral disk. He is admitted for a L3-4 Laminectomy. • A 50-year old man has a right hepatoma. He is admitted for a right partial hepatectomy. • A 50-year old man has cancer involving the posterior tongue. He is admitted to the surgical ward for a Hemi-Glossectomy and possible Laryngectomy. • Identify some anaesthetic problems?

  5. L3-4 Laminectomy. • Operation site is the back • Patient lies prone • Poor access to airway

  6. Right partial hepatectomy. • Hepatitis B or C carrier • Underlying liver cirrhosis • Potential for massive blood loss • Impaired clotting • Major surgery – unstable post operatively

  7. Hemi-Glossectomy. • Difficult to intubate • Management the airway • Access to the patient

  8. Summary & what are the solutions? • Difficult positions (Prone) • Blood loss (Hepatectomy) • Replacement • Assessing blood loss • Impaired coagulation • Airway difficulties (Head & neck surgery) • Intubation • Maintenance

  9. Vignette (3) & Question. • A elderly woman is admitted to the surgical ward with breast cancer. She is scheduled for a simple mastectomy. She is visited before her surgery by the anaesthetist. • How is going to assess the her “fitness” for anaesthesia and surgery? • Will she tolerate the anaesthetic / surgery? • (List key points)

  10. Answers. • Inquiry about health • General • Specific – related to anaesthesia • Clinical examination • Modified for anaesthesia • Review / Order relevant investigations

  11. History & Examination • What is the focus of: • The general inquiry? • Questions specifically related to anaesthesia? • Clinical examination?

  12. Airway assessment: • Why is it necessary? • What examination?

  13. What are the LEMON or MELON Physical signs for predicting difficult intubation?National Emergency Airway Management Course • Look externally, • Evaluate the 3-3-2 rule, • Mallampati, • Obstruction, • Neck mobility

  14. Mallampati

  15. Mallampati score?

  16. Laryngoscopy views

  17. Vignettes (4) and Question • 5-year-old child for tonsillectomy. • 45-year old man with a perianal abscess. • 32-year old lady with a thyroid nodule. • What data does the nursing observation chart contain? • Which observations are of most interest in your patient.

  18. Vignettes (5) & Question. • Elderly woman with a fractured hip. • A middle aged man with intestinal obstruction requiring an exploratory laparotomy. • A 60-year-old woman with mitral valve replacement for a hysterectomy. • What “laboratory” investigations are indicated in your patient? • Justify you choices.

  19. Vignettes (6) and Question • A patient admitted for open heart surgery. • A pregnant woman admitted for elective Caesarean Section. • A patient admitted for head and surgery for nasopharyngeal carcinoma. • What issues should the anaesthetist explain and/or discuss with the patient?

  20. Vignette (7) and Question. • A 45-year-old private patient requires a shoulder arthroscopy. His anaesthetist prescribes him Diazepam 10mg orally 1h preoperatively. • What are the reasons for giving Diazepam? • What are the alternatives?

  21. Question • How can we assess anaesthetic risk?

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