[麻醉讀書筆記 78-day Anesthesia Secrets] Day 17 - PREOPERATIVE EVALUTION

 

Anesthesia Secrets 78 Chapter, Day 17

🙀There is no shortcuts, only hard work. 💪

#Day 17 - Preoperative Evaluation

#Ref: Anesthesia Secrets, 4th edition. Chapter 17, Preoperative Evaluation

Preoperative Evaluation

[ASA Class]

Basic definition (就是一種互相溝通的語言)

• Class 1: normal, healthy
• Class 2: "mild" systemic disease
• Class 3: "severe" systemic disease
• Class 4: severe systemic + "constant" threat to life
• Class 5: moribund pt "not expected to survive" w/o the OP
• Class 6: Brain-dead for donor purposes
• E: emergency OP

[Fast before surgery]

• 這是 ASA 1999 的 Guideline 了
• Clear liquid: 2 hr
• Non-human mild: 6 hr
• Light meal (e.g. toast + clear liquid): 6 hr
• Full meal: 8 hr

[如果只是 Elective Surgery 到底要多久抽血一次]

這本裡面提到的:

• 除非有什麼變化, 以下是 OK 的
• CXR, EKG: 6 months
• Biochem, Hb/Hct: 1 month
• Coagulation: **1 week**

[跟 Heart 相關的評估]

(在評估上, 甚麼是 active cardiac conditions)

→ 需要 immediate evaluation and treatment before undergoing OP, 要注意 4 點

• Unstable coronary syndromes (unstable or severe angina, recent MI)
• Decompensated HF
• Significant arrhythmias (symptomatic ventricular arrhythmias, high-grade AVB, symptomatic bradycardia)
• severe valvular disease (symptomatic MS, severe AS)

→ 另外有一個表格 "Revised Cardiac Risk Index", 可以評估 Risk of Major Cardiac Event

[跟 Coagulation 相關的評估]

• PLT 需要多少: 5w
• 討論一下 Warfarin (vitamin K antagonist)
• 重點就是衡量: intra-OP bleeding vs. thromboembolism
• → 所以如果 high risk of thromboembolism 但是又必須停的 → 就可以靠 Heparin 來 Bridge
• Warfarin (long half-life: 2.5d) vs. Heparin (short half-life: 1.5 hr)
• 所以 Bridge: 4d 前停 Warfarin → 用 Heparin bridge

[關於小朋友 感冒 vs. 延後手術]

• 有趣的數據: young children average 5-8 URIs per year, 所以如果都要延後就都不用開刀了
• 所以 Elective surgery is postponed in children with severe URI or LRI
• severe nasopharyngitis, purulent sputum, high fever, deep cough, associated auscultatory findings of wheezes or rales

#綠油油的. #娘家.  By Mark.

By Mark, 馬克

💬 E-mail: mata.assembled@gmail.com