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PRE ANESTHETIC EVALUATION.pptx
- 2. INTRODUCTION • Is a requisite component for any anaesthesia • A patient’s pre operative anesthetic evaluation can uncover findings tha will change anesthetic plan • PAE includes an effective medical history • physical examination • relevant lab or diagnostic tests • consultation from other physicians if needed
- 3. OBJECTIVES o Evaluate patient’s medical condition o Optimise patient’s condition for anesthesia o Determine and minimise risk factor anesthesia o Plan anesthetic technique and perioperative care o Develop a rapport with the patient and reduce the anxiety o Inform and educate the patient about anesthesia o Obtain informed conscent for anesthesia o ERAS (Enhanced Recovery After Surgery)
- 4. BENEFITS Reduce health care cost Improved acceptance of regional anesthesia Short duration of hospitalisation Avoid delays,cancellation,complications
- 5. Pre anaesthetic assessment Personal interview in the ward operating theatre pre anesthetic clinic Preset questionairs In case of emergency surgery where early consultation is not always possible Documentation is must
- 6. 1 Medical history Biodata Current illness Diagnosis and proposed surgery Previous medical history and medications Personal history Allergic history Previous anesthesia and surgical history Family history of anesthetic complication Menstrual history
- 7. 2 Physical examination Vital signs General examination Systems examination Airway Peripheral venous access Spine examination Height and weight( BMI) ASA physical status
- 8. ASA physical classification system ASA 1 Normal healthy patient ASA 2 Mild systemic illness ASA 3 Severe systemic illness ASA 4 Severe systemic illness that is a constant threat to life ASA 5 A moribund patient not expected to survive without surgery ASA 6 Brain dead patient whose organs are harvested
- 9. Airway examination Mouth opening : an inter incisor distance of 3cm or greater Mallampati score :examine size of tongue in relation to oral cavity Grade 1: soft palate,faucial pillers,and uvula visible Grade 2: soft palate and faucial pillers visible Grade 3: only soft palate visible Grade 4: Only hard palate visible
- 12. Upper teeth overbite Thyromental distance Sternomental distance Mentohyoid distance Neck mobility Radiotherapy or surgical scars,facial hair Dentition : loose tooth, artificial dentures,missed tooth
- 14. Thyromental distance Upright Full neck extension Distance from the upper border of thyroid cartilage to bony point of mentum Distance <6.5cm is difficult
- 16. Predictors of difficult intubation Mouth opening <3cm Limitations neck movements Micrognathia –receding mandible Macroglossia Protrusion of teeth- buck teeth Short neck Morbid obesity
- 17. Respiratory system Cardinal symptoms Cough Dyspnoea Snoring, sleep apnoea h/o smoking,tobacco Recent LRTI Risk of aspiration PHYSICAL EXAMINATION
- 18. Evaluating cardiac disease Goals are to identify the risk factors,severity of the disease,need for pre op interventions, and modify the peri op adverse events NYHA functional classification Account for 50% of all peri op deaths CARDINAL SYMPTOMS dyspnoea Chest pain Palpitation Syncope,etc
- 20. Revised cardiac risk index Undergoing elective major non cardiac surgery High risk type of surgery History of ischemic heart disease h/o congestive heart failure h/o cerebro vascular disease Pre operative s.cr >2mg/dl
- 21. Clinical predictors for increased preoperative cardiac risk Metabolic equivalent :best to have more than 4METS 1 METS –eats,dress up,use toilets 2-3 METS :Walk a block on level ground 4 METS : Climb a flight of stairs 10 METS :swimming ,tennis,etc
- 22. Neurological examination Mental status Cerebro vascular disease Seizure history Pre existing neuro muscular disease Nerve injuries Spinal cord injuries
- 23. Endocrine system Diabetes Thyroid disease Parathyroid disease
- 24. Laboratory testing Reasonable testing Baseline investigation CBC SERUM ELECTROLYTES RFT LFT RBS SEROLOGY ECG AND CHEST XRAY
- 25. Bleeding time Pt-INR TFT IN Case of thyroid disease
- 26. Arrhythmias/ECG abnormalities Further work up or therapy needed new onset AF Symptomatic bradycardia High grade heart block (2nd or 3rd degree) Uncontrolled AF VT Prolonged QT New LBBB RBBB
- 27. DOCUMENTATION A written summery of the pre anaesthetic assessment , orders,arrangements should be documented legibly
- 28. Preperation for anaesthesia patiet’s conscent Fasting guidelines Antibiotic prophylaxis Describe which medication has to sto and which one to continue
- 29. Fasting guidelines To reduce occurrence of aspiration Upto 8h= hrs unrestricted Upto 6 hrs Light meal/ formula milk Upto 4 hrs Breast milk Upto 2 hrs Clear liquids only
- 30. Drugs hold on day of surgery Diuretics( some clinicians stop) Insulin and OHA Anti coagulants T.CLOPIDOGREL -5 days prior to surgery ACE Inhibitors ,ARB (some clinicians stop)
- 31. Pre medications Alleviate anxiety/ sedation/ amnesia eg: MIDAZOLAM Reduce risk of reflux eg: RANITIDINE/ METOCLOPRAMIDE Reduces secretions eg: GLYCOPYRROLATE Antibiotic prophylaxis: at least 1 hr prior to surgery
- 32. “ ” THANK YOU