pre op eval

7/31/2019 Pre Op Eval

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PREOP EVALUATION

GOAL: -

Reduce morbidity of surgery.

Increase quantity but decrease cost of preop

care.

Return patient to desirable functioning as

quickly as possible.


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PREOP EVALUATION

PURPOSE OF MEETING BETWEEN PATIENT &

ANAESTHETIST: -

Obtain pertinent information about patients

medical history, physical conditions, thus

determine which tests & consultations needed.

Obtain informed consent.


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Educate patient about anaesthesia preop care

& pain treatments to allay anxiety & facilitate

recovery.

Guided by patient choice & risk factors careplans to be followed.

Make preop care more efficient & less

expensive.


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PREOP EVALUATION

SUMMARY: -

Optimize patient health before surgery.

Plan most appropriate perioperative

management. Reduce rate of cancellation.

Increase patient satisfaction.


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PREOP EVALUATION

Preop evaluation gives

practitioners confidence that

they will not be surprised by

unexpected patient conditions& gives patients confidence

that health care system is

responding to their individualconditions.


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PREOP EVALUATION

A study at the University of Florida inGainesville formed that preop evaluationprovides information leading to changes incare plans for more than 15% of all healthypatient & 20% of all patient in general.

Example of conditioner care: -

- Gastric reflux.

- IDDM & NIDDM- Asthma

- Suspected different int.


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PREOP EVALUATION

HISTORY: -

In the beginning preop assessment relied

only on accurate history taking & physical

examination. In 1960s multiphasescreening lab tests were added to the

procedure


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PREOP EVALUATION:CHANGING

NATURE !!!

Is patient in optimalhealth

Can or should the patientphysical or mental

condition be improved

before surgery.


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PREOP EVALUATION

Does patient have any health problem or useany medication that could unexpectedlyinfluence perioperative events.

Job of anaesthesiologist is not simply to putpatient to sleep & wake him earlier aftersurgery, but to maintain.

Pain therapy.

Haemostatis


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PREOP EVALUATION

Anaesthesiologist must interfere

with stress response induced by

pain & manage the patients

medical problems.


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HISTORYFIRST AREA OF CONCERN

Last anaesthesia.

Any problem (Also in family members)

Allergies.

Blood tests in last 6 months

CXR in last 2 months.

ECG in last 2 months

Medications.Artificial aids (hearing, eyes, denture etc)


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CVS: - Congestive heart failure (CHF) highest risk

Cardiomyopathy

IHD

Valvular HD

HTN

Cardiac rhythm

Carditis

Arteritis.


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RESP & AIRWAY PROBLEMS: -

Evidence of airway obstructions Restricted jaw movements.

Smoking.

Occupational hazard.

Chr bronchitis

Emphysema

Chr infection


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HEPATIC OR GI DISORDERS: -

Hiatus hernia

Hepatitis, Liver ds, Malaria etc. Gall bladder ds

Bloody or tarry stools.

? Frequent, nausea with vomiting

Rx history

BLEEDING PROBLEMS: -

Bleeding Tendency.Anemia.

BT history


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RENAL DS: -

- Kidney problem.

- RF problem.

- Dialysis.

- Infections.- Calculi.

(Voluntary avoidance of food having a high

proteins content is s/o Renal Disease)


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ENDOCRINE DISTURBANCES: -

- End organ effects of DM,

- Thyroid,- parathyroid,

- pituitary,

- adrenal &- carcinoid disease


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QUESTIONS: -

- Frequency of micturition

-diurnal variations


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NEUROLOGICAL DS: -

- QUES

- seizure

- stroke- migraine

- tremors

- nv injury

- numbness,tingling

- antidepressants

- sedatives

- .MUSCULOSKELETAL DS: -

- Arthritis

- LBA


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SENSITIVE AREA OF CONCERY: -

- Pregnancy.

- Illicit drug use.

- AIDS etc

PHYSICAL EXAMINATION: -

- G/E

- S/E


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THANK YOU

pre op eval

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