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  • Writer's pictureGasNovice

Pre-op Anaesthetic Assessment (excluding airway exam)

Ana has already done a great job in her video lecture. I want to bring together some of the resources that are fundamental to the pre-op visit. This was initially published as a twitter thread and I've expanded a little here. I hope the information is useful and directs you to resources that avoid wasted time searching though the internet.

The first official document to be aware of is probably the Association of Anaesthetists safety guideline that is due to be updated soon . If you are a UK trainee then anything by the AAGBI (Association of Anaesthetists) is considered fundamental and examinable. There are lots of other guidelines on their site, which are generally quick reads. It's a good idea to sign up and get the app, or bookmark the site

Then check out ASA patient classifications (spoiler alert: ASA 1 is very rare).

This classification does get updated periodically. It's current form usefully contains examples for each class. Knowing the ASA class determines much of what comes later...

Next have a look at current NICE recommendations for pre-op investigations in elective surgery. when you read it you'll see why ASA class comes first. The NICE guidance consists of MANY tables. However, the information, once you read it, can be distilled down pretty succinctly

In terms of peri-op management of medications... this really can be confusing and the chances are there are many drugs you will not have encountered often enough yet to make good clinical calls for. That's OK! In general, you will be having conversations with your supervisor/mentor about the management of medications.

Anyway, on the day of surgery its usually too late to make any decisions about the drugs. so you'll probably just have to crack on. The reality is that surgeries will go ahead whether or not a drug is appropriately held in 99% of cases.

For "official" advice on the commonest medications though...the UKCPA has you covered in their Handbook of Perioperative Medicines

Special patient groups to be careful with are: immunocompromised, transplant, anticoagulated, diabetic. If your patient is under the care of a specialist tertiary/referral centre then it's usually wisest to check with them about peri-operative drug management.

Anticoagulants are a pain and there are guidelines from the BSH and the Association of Anaesthetists has its own guidelines for regional anaesthesia. However, most hospitals will have policies relating to per-operative anti-platelet and anticoagulant management.

Diabetic patient management comes courtesy of? you guessed it! ...the Association of anaesthetists

Your anaesthetic department will have some form of pre-assessment clinic that has been completely up-ended during COVID. However it will still function in some form and the information ad plans are very useful. So find out what happens in this clinic and how their assessments can be found and read in the patient's notes.

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