Surgery Preoperative Assessment

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Questions and Answers

What is the key factor in improving outcome and lowering the length of hospital stay?

Optimized patient's overall health status

Uncovering of hidden conditions that could cause problems during surgery

Decreasing the stress response to surgery and trauma (correct)

Administration of anesthesia

What is a primary goal of preoperative evaluation and preparation?

Development of an appropriate postoperative care plan

Documentation of the condition(s) for which surgery is needed (correct)

Documentation of the patient's overall health status

Assessment of the surgical team's performance

What can inadequate preoperative preparation of the patient lead to?

A major contributory factor to perioperative mortality (correct)

A decrease in perioperative morbidity or mortality

Reduced length of hospital stay

Improved surgical outcome

What is a factor that influences the stress response to surgery?

Amount of intraoperative blood loss Signup and view all the answers

What is the purpose of educating the patient about surgery and anesthesia?

To reduce anxiety and facilitating recovery Signup and view all the answers

What is a goal of perioperative risk determination?

To reduce the patient's surgical and anesthetic perioperative morbidity or mortality Signup and view all the answers

What is a factor that can cause problems during and after surgery?

Hidden conditions Signup and view all the answers

What is the purpose of optimizing the patient's medical condition?

To reduce the patient's surgical and anesthetic perioperative morbidity or mortality Signup and view all the answers

What is the primary goal of preoperative medical assessment?

Reduce surgical and anesthetic perioperative morbidity or mortality Signup and view all the answers

What factors contribute to perioperative risk?

Preoperative medical condition of the patient, the invasiveness of the surgical procedure, and the type of anesthetic administered Signup and view all the answers

Why should laboratory investigations be ordered?

When indicated by the patient's medical status, drug therapy, or the nature of the proposed procedure Signup and view all the answers

What is essential to any preoperative evaluation?

History and physical examination Signup and view all the answers

What should be done for patients with comorbidities?

They should be optimized for the procedure Signup and view all the answers

When should consultations with appropriate medical services be obtained?

As soon as possible Signup and view all the answers

What is the most important component of the preoperative evaluation?

The history Signup and view all the answers

What should be included in the history during the preoperative evaluation?

Past and current medical history, surgical history, family history, social history, history of allergies, and current and recent drug therapy Signup and view all the answers

What should be included in a patient's history when taking a family history of adverse reactions associated with anesthesia?

Medical history of all first-degree relatives Signup and view all the answers

What should be focused on when taking a birth history in children?

Risk factors such as prematurity at birth, perinatal complications and congenital chromosomal or anatomic malformations Signup and view all the answers

What should be included in a complete review of systems?

All systems to look for undiagnosed disease or inadequately controlled chronic disease Signup and view all the answers

What is the minimum requirement for a focused preanesthesia physical examination?

Assessment of the airway, lungs, heart, and documentation of vital signs Signup and view all the answers

What should be considered when ordering laboratory tests?

The risk-benefit ratio of any ordered lab test Signup and view all the answers

What percentage of patients will have laboratory results that fall outside the normal range when studying a healthy population?

5% Signup and view all the answers

Why should laboratory tests be ordered based on information obtained from the history and physical exam?

Because it helps to identify relevant diseases Signup and view all the answers

What should be obtained in all patients?

A history of medication use Signup and view all the answers

What does the ASA grading system primarily assess?

The patient's physical state Signup and view all the answers

What is the correlation between increasing physical status and mortality?

Increasing physical status is associated with increasing mortality Signup and view all the answers

What percentage of surgical patients experienced at least one complication in a large study?

17% Signup and view all the answers

What is a common category of surgical complications?

Cardiac complications Signup and view all the answers

What is a factor that increases the risk of surgical morbidity and mortality?

Advanced age Signup and view all the answers

What is a common disease associated with an increased risk for surgical complications?

Diabetes mellitus Signup and view all the answers

What type of surgical procedure is frequently associated with increased perioperative morbidity and mortality?

Major vascular surgery Signup and view all the answers

Why do older persons have a higher risk of surgical complications?

Due to their increased likelihood of underlying disease states Signup and view all the answers

What is the main concern in urgent and emergency procedures?

Limited opportunity for preoperative evaluation and treatment Signup and view all the answers

What is a common cause of morbidity and mortality in anesthesia?

Airway problems and failure to provide adequate ventilation Signup and view all the answers

What is the purpose of the ACC and AHA task force report?

To provide guidelines for perioperative cardiovascular evaluation Signup and view all the answers

What is the necessary period for the myocardium to heal after an infarction?

6 weeks Signup and view all the answers

What is the classification for patients with coronary revascularization done within the preceding 40 days?

High-risk patients Signup and view all the answers

What is the increased perioperative risk for patients with major predictors?

Five times greater Signup and view all the answers

What is the classification for patients with well-established but controlled coronary artery disease?

Intermediate-risk factors Signup and view all the answers

What should be considered for patients with major predictors?

Only vital or emergency surgical procedures Signup and view all the answers

Study Notes

Case History & Preoperative Assessment

Surgical procedures and anesthesia administration are associated with a complex stress response, which can lead to adverse metabolic and hemodynamic effects in the perioperative period.
Decreasing the stress response to surgery and trauma is key to improving outcomes, reducing hospital stays, and lowering healthcare costs.

Primary Goals of Preoperative Evaluation and Preparation

Document the condition(s) for which surgery is needed
Assess the patient's overall health status
Uncover hidden conditions that could cause problems during and after surgery
Determine perioperative risk
Optimize the patient's medical condition to reduce morbidity and mortality
Develop an appropriate perioperative care plan
Educate the patient about surgery, anesthesia, intraoperative care, and postoperative pain treatments
Reduce costs, shorten hospital stays, reduce cancellations, and increase patient satisfaction

Importance of Preoperative Medical Assessment

Reduces patient's surgical and anesthetic perioperative morbidity or mortality
Returns the patient to desirable functioning as quickly as possible
Identifies risk factors for cardiac and pulmonary complications
Determines the patient's functional capacity

Components of Preoperative Evaluation

History: past and current medical history, surgical history, family history, social history, history of allergies, current and recent drug therapy, unusual reactions or responses to drugs
Physical examination: focused preanesthesia physical examination, including assessment of airway, lungs, and heart, with documentation of vital signs
Laboratory workup: ordered based on information obtained from history and physical exam, age of the patient, and complexity of the surgical procedure

Indications for Specific Preoperative Tests

Drug history: obtained in all patients
Perioperative risk assessment: a function of preoperative medical condition of the patient, invasiveness of the surgical procedure, and type of anesthetic administered

ASA Grading System

Introduced to describe the physical state of a patient
Correlates with risk of anesthesia and surgery
Extremely useful and should be applied to all patients presenting for surgery
Increasing physical status is associated with increasing mortality

Surgical Complications

Occur frequently (17% of surgical patients)
Fall into three categories: cardiac, respiratory, and infectious complications
Risks depend on individual factors and type of surgical procedure
Advanced age, underlying disease states (e.g., respiratory and cardiac disease, malnutrition, and diabetes mellitus), and major vascular, intraabdominal, and intrathoracic surgical procedures increase risk

Anesthetic Problems

Airway problems and failure to provide adequate ventilation leading to hypoxia are significant
Number of critical incidents involving anesthetics alone appear to be decreasing in recent years

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Description

Learn about the importance of preoperative evaluation and preparation in surgery, including the stress response to surgery and anesthesia, and its impact on patient outcomes.