4. Pre-operative Assessment
⢠The purposes of pre-operative visit.
⢠Taking history .
⢠Physical Examination.
⢠Risk Assessment.
⢠Common causes for postponing Surgery.
5. The purposes of pre-operative visit
⢠Establish report with the patient.
⢠Taking a history .
⢠Order special investigation.
⢠Assess the risk of anaesthesia.
⢠Start pre-operative management.
⢠Discussion about pre-operative and plan the
anaesthetic management.
⢠To avoid any drug induction or not.
⢠Introduce a treatment in early post-operative period.
.
6. History Taking
⢠Chart review
⢠Present illness
⢠Family History: porphyria, malignant
hyperpyraxia, haemophilia, Cholinesterase
abnormalities and dystrophy myotonica .
⢠Disease of C.V.S & Respiratory, dyspnoea,
paroxysmal nocturnal dyspnoea, orthopnoea,
angina , MI .
8. A history of previous anaesthesia .
⢠Allergy to drugs .
⢠Sore throat and headache
⢠Post-operative nausea or vomiting.
⢠Expose to Halothane within 3 months prior to
Surgery
⢠DVT or Respiratory problems.
⢠Difficulties with tracheal intubation.
9. History Taking
⢠Allergy to drugs, food, antibiotics, anesthetic
agent, latex allergy and atopic patient
⢠HBV,HCV,HIV carriers have additional risk on
staff.
⢠Taking a special method with infected patient:
10. Pregnancy
⢠If itâs elective surgery then postpone it till
delivery.
⢠Many anaesthetic are teratogenic
especially in early stage.
⢠They my induct spontaneous abortion.
11. Smoking
⢠Smoking indicate: CVS problems , chronic
bronchitis or Lung CA.
⢠It cause tachycardia, increase peripheral
resistance, decrease the availability of
O2 by 25%, and the Respiratory
complication will increase by 6 folds.
⢠It must be stopped 1 month to
operation
Or at least 6 hours before anesthesia .
12. Alcohol
⢠Alcohol: it cause induction of liver enzyme,
hepatic & cardiac damage, delirium tremors
post-operatively as result of drug withdrawal.
⢠Drug history: many drugs interact with the
anaesthesia
⢠Drugs must be stooped before surgery and
anesthesia (contraceptive tablets .warfarin
and MAOI )
13. Drug History
⢠CVS medication: ACE Inhibitors, Diuretics, B-
Blockers, Calcium channel blockers
⢠Antibiotics: Aminoglycosides,Sulphonamides.
⢠Anticoagulant: Warfarin, Aspirin,
contraceptive, hormone replacement therapy
⢠Lithium and Insulin .
14. Physical Examination
⢠Full examination must be done even if itâs a minor
surgery.
⢠General: color, activity, weight, dehydrated, & type
of breathing.
⢠CVS: pulse volume, rate, and pressure, heart sounds,
& BP.
⢠RS: Breathing sound, chest , airway and trachea.
⢠Assessment of the ease of tracheal intubation.
16. Investigation
⢠Routine investigation : urine analysis & CBC
⢠Medically fit pt less than 40 yr old ( Hb & sugar
in urine )
⢠Medically fit pt more than 50 yr old ( Hb &
sugar in urine + chest X-ray & ECG )
⢠More investigation, if the pt has any medical
diseases.
17. Risk Assessment
⢠Overall mortality rate from surgery is 0.6% while
from anaesthesia 1/1000.
⢠The information gathered is used to predict the
patient absolute mortality
Grade status absolute mortality
1 a normal healthy patient 0.1
2 mild systemic disease 0.2
3 severe systemic disease 1.8
4 incapacitating systemic disease 7.8
5 a moribund patient 9.8
18. Causes of death due to anaesthesia
⢠Inadequate preoperative assessment.
⢠Inadequate supervision & monitoring inter-
operative period.
⢠Inadequate post-operative care.
19. Common causes for postponing surgery
⢠Acute upper respiratory tract infection.
⢠Untreated medical diseases.
⢠Inadequate resuscitates pt in emergency( 1/3
of fluid lost ) in dehydrated pt & 100 BP in
shock pt.
⢠Recent ingestion of food.
⢠Failure to obtain informed consent.
⢠MI : wait 6 months
20. Pre-operative preparation
for surgery & anaesthesia
⢠History , physical examination & investigation
⢠Preoperative fasting
⢠Providing information to the patient & gaining
a consent
⢠Collect or Prepare of the blood product
⢠Organize appropriate staff and equipment in
the theater
21. Pre-operative preparation
for surgery & anaesthesia
⢠BP should not be more than 100-105 mmhg
diastolic.
⢠Control cardiac diseases,
⢠FBS = 130-180 mg/100cc bld.
⢠Bld preparation for major surgery.
⢠Drugs which may be given in the day of
operation: steroid, aminophyline, heparin,
antibiotic, & insulin.
22. Pre-Medication
The objective of pre-medication
⢠Allay anxiety and fear.
⢠Reduce secretions.
⢠Enhance the hypotonic effect of anaesthetic agents.
⢠Reduce postoperative nausea & vomiting.
⢠Produce amnesia.
⢠Reduce the volume & increase pH of gastric
contents.
⢠Reduce vagal reflexes.
⢠Limitation of sympathoadrenal response
23. Anti cholinergic
⢠They are used to :
1- antisialagogue effect ( reduce secretion )
2- sedative and amnesic effect
3- prevention of reflex bradycardia : as
prophylactic and treatment of bradycardia
24. Anti cholinergic
⢠Atropine:
⢠given IM in a dose 0.6 mg for adult & 0.01 mg/kg.
⢠It reduce the oral and respiratory secretion.
⢠Itâs highly indicated in anal surgery, eye surgery,
bronchoscope, suxamethonium single dose, and
Ketamine.
⢠It should not be used for pt with high tem,
thyrotoxicosis, heart failure controlled by digoxin.
25. Anti cholinergic
⢠Scopolamine:
⢠Given IM,IV, or SC in a dose 0.4.
⢠It produce amnesia, hallocination, and reduce
salivation.
⢠It should not be given to a pt below 6 yr and
above 60 yr.
26. Anti cholinergic
⢠Side effects :
1 - CNS toxicity : restlessness , agitation ,
somnolence , convulsion & coma
2 - reduction in lower esophageal sphincter tone
3 - tachycardia
4 â visual impairment
5 â pyrexia
6 â excessive drying
27. Benzodiazepines
⢠They are used to :
1 â relief anxiety
2 â sedation
3 â anterograde amnesia
4 â muscle relaxants
28. Benzodiazepines
⢠Diazepam: 0.2 mg/kg. long acting, night
before the operation.. It produce light
anaesthesia.
⢠Midazolam: 0.1 mg/kg. shorter in action.
Hepatic & non-hepatic elimination and
doesnât cause thrombosis.
29. Narcotic
⢠They are used to :
1 â production sedation
2 â relieve pain
3 â when using opioids ,lower concentration of
anesthetic agent is required for maintenance
of anesthesia because of its synergistic effects
with anesthetics .
30. Narcotic
⢠Pethidine: 1.5 mg/kg with mild atropine like
action. Moderate to sever pain.
⢠Morphine: 0.15 mg/kg. Itâs more potent with
incidence of vomiting.
⢠Omnapone: itâs extract of opiate. 50%
morphine, 25% morphine like action, and 25%
papaverine.
31. Narcotic
⢠Side effect :
1 â depression of ventilation and delay
resumption of spontaneous ventilation at the
end of anesthesia .
2 â nausea and vomiting
3 â Rt upper quadrant pain