University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

62

Pages:

3
Author:

Mariam A. A.

Assessment for low and intermediate risk surgery • ASA physical status classification system: - Used to assess and communicate a patient’s pre-anaesthesia medical comorbidities. The emergency patient • • • • • • • • Anaesthesia given due to an emergency. Differs from elective anaesthesia. The need for this is predicted to increase, due to an increase in the elderly population. The unpredictable nature provides a greater challenge to provide a service that meets the recommended standards of care. Patients are at risk of deterioration if their treatment is delayed. The urgency of the case should be clearly and unambiguously coded. Some aspects of the preoperative assessment differ as compared to the elective anaesthesia and surgery patient. Non-elective anaesthesia per-operative assessment should include: - A clear diagnostic and management plan made on admission. - Early identification of comorbidities (for example, diabetes, dementia, cardiac pacemakers etc.) and their management according to hospital guidelines. - Medicine reconciliation to assess the risk of existing medications (including anticoagulants) and the risk associated with stopping long term medication if needed. - Per-operative investigations and testing as appropriate. - Communication of mortality risk to members of multidisciplinary team; this allows early senior input, including senior members of the anaesthetic team and allocation of resources proportion to the patient’s risk of death following surgery. - Plan for post-operative care. Anaesthetic risks • • • • • • • • • • • • • • • Injury at injection site. Infection Breathing issues. Short term damage to the nerves. Allergic reaction, such as asthma. Having sensation and pain during the operation. Damage to the mouth, teeth, lips or tongue. Damage to the vocal cords or the larynx. Lung damage. Heart attack. Brain damage. Stroke kidney failure. Paraplegia Quadriplegia Postoperative planning • • • • • • Respiratory, cardio-vascular and there applicable, neurological status prior to the transfer from theatre to the post-operative anaesthesia care unit (PACU) should be noted. Incidents arising during this period and their management should be documented. Plan for pain management, fluid therapy and oxygen therapy if required. Discharge plan including destination on transfer from operating theatre or PACU. Space should be available for documenting any post-anaesthesia visits. Documentation of outcomes, including clinical indicators, audit and quality assurance information. Psychological factors • • • • • Pre-operative anxiety Depression Low self-efficacy Pain sensitivity Heuristics Medicolegal issues • • • • • • Informed consent Record keeping Allegations against administration, skill and performance. Dental damage Practitioner behaviour. Negligence • • Duty of care Breach of duty