Peri-operative Assessment

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PeriOperativeSurgical complications / technical challenges

  • Anti-coagulant use
  • Previous intervention at surgical site
  • Obesity
  • Aberrant anatomy

Anaesthetic risk

  • Cardio-respiratory co-morbidities – e.g. MI, LVF, COAD, HT
  • Cerebrovascular disease e.g TIA, CVA
  • Cardio-respiratory fitness e.g. exercise tolerance (very important), baseline oxygen saturation, ejection fraction, pulmonary function tests
  • Aspiration risk e.g. fasting status, obesity, frequency of reflux symptoms, loose teeth
  • Difficult intubation e.g. small mouth, short/stiff neck, ENT problems, previous anaesthetic problems

Likelihood of post-operative complications or need ICU/HDU?

  • Ventilatory or Intropic support – cardiorespiratory illness (again), cardiothoracic surgery
  • DVT/PE risk e.g. prolonged bed rest, obese
  • Airway risk e.g. airway/ENT procedure
  • Neurological deterioration e.g. neurosurgical or cerebrovascular surgery

Wound healing issues?

  • Local factors e.g vascular disease, skin infection, obesity, poor nutrition
  • Systemic factor e.g. diabetic, chronic steroids

Functional recovery and rehabilitation?

  • Functional assessment / ADLS
  • Social supports and assistance
  • Alternative places for convalescence and recovery

Anaesthetic complications

  • Cardiac – ischaemia, infarction, arrhythmia
  • Circulatory – hypotension
  • Respiratory – infection, aspiration, atectasis
  • Airway damage / Dental damage
  • Failure to oxygenate > Hypoxic brain damage 
  • Awareness

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