The document outlines anaesthetic fitness criteria and a pre-surgery checklist focusing on assessing cardiac risk factors, which include patient-related, surgery-related, and test-related considerations. It details various cardiac risk indices like the Goldman risk index and revised cardiac risk index, alongside their scoring systems and associated complications. Additionally, it describes classifications for angina severity and functional status based on the Canadian Cardiovascular Society grading scale and the New York Heart Association classification.

1. Anaesthetic Fitness Criteria
& Pre Surgery Checklist
Mr Harshad Khade
M.Sc. Medical Technology
PRN :- 20040143003

2. Cardiac Risk Index

3. Factors To Be Considered
When Assessing Cardiac Risk.
Patient related factors
• Age
• Chronic diseases
• Functional status
• Medical Therapy
• Implantable devices
• Previous surgeries
Surgery related factors
• Types of surgery
• Urgency of Operation
• Duration of the
operation
• Possibility of Blood loss
and Fluid shifts
Test related factors
• Sensitivity and
specificity of a test
• Effect on management.

4. Cardiac Risk Index
❖Goldman Risk Index
❖Revised Cardiac Risk Index
❖Canadian Cardiovascular Grading Scale
❖NYHA Classification

5. Goldman Risk Index
Risk Factor Pom
ts
1) Presence of hear failure signs (ventricular gallop S3) 11
2) Recent Myocardial Infraction 10
3) Arrhythmia 7
4) >5 PrematureVentricular Contraction / Minute 7
5) Age >70 Years 5
6) Emergency Operations 4
7) Poor General Health Condition 3
8) Intrathoracic, Intraperitoneal Or Aortic Surgery 3
9) Severe Aortic Stenosis 3

6. Subsequently It Assigns A Class
Class Points Risk Of Cardiac
Complications
Problem Of Life
Threatening
Complications
Chances of
Cardiac Death
1 0 – 5 1% 0.7% 0.2%
2 6 – 12 7% 5% 2%
3 12 – 25 14% 11% 2%
4 26 - 53 78% 22% 56%

7. Revised Cardiac Risk Index
Clinical Variable Poin
ts
1) High Risk Surgery 1
2) History Of Ischemic Heart Disease 1
3) History Of Congestive Heart Failure 1
4) History Of Cerebrovascular Disease 1
5) Insulin Treatment For Diabetes Mellitus 1
6) Pre Operative Serum Creatinine Level > 2.0 mg/dl 1

8. Interpretation Of Risk Score
Risk Class Points Risks Of Complications
(%)
1.Very Low Risk 0 0.4%
2. Low Risk 1 0.9%
3. Moderate Risk 2 7.0%
4. High Risk 3+ 11.0%

9. Canadian Cardiovascular Society
Grading Scale
Class Angina severity
Class 1 Angina during strenuous.
Prolonged physical activity.
Class 2 Slight limitation with angina.
Only during vigorous physical activity.
Class 3 Moderate limitation.
Symptoms with every day living activity.
Class 4 Sever limitation.
Inability to perform any activity without angina.
Angina at rest.

10. NYHA Classification
Class Defination
NYHA class 1 No symptoms.
With normal physical activity.
Normal functional status.
NYHA class 2 Milled symptoms.
With normal physical activity. Comfortable at rest.
Slight limitation of functional status.
NYHA class 3 Moderate symptoms.
With less than normal physical activity. Comfortable only at rest.
Marked limitation of functional status.
NYHA class 4 Sever symptoms.
With features of heart failure,
With minimal physical activity and even at rest.
Sever limitation of functional status.

11. Thank You