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PRE-OPERATIVE ASSESSMENT AND PREMEDICATION

Prepared by:

Assistant Professor Wail Khraise

OBJECTIVES:
1. 2. 3. 4. 5. 6. 7. 8. To minimize mortality and morbidity To put the patient in optimal condition To put a plan for anaesthesia To put a plan for postoperative care To get patient consent Explanation To ** upper airway To prescribe premedication if required
Ass. Prof. Wail Khraise April 2013 Slide 2

PMH P.S.H Allergies NPO MP & teeth Drugs:


Warfarin M.A.O.I Contraceptive pills Antihypertensive Diabetic drugs

Smoking Alcohol Lab X-ray ECG C.B.C Urine analysis F.B.S

Ass. Prof. Wail Khraise

April 2013 Slide 3

GOLDMANS INDEX OF CARDIAC RISK IN NON-CARDIAC PROCEDURES


Risk factor Third heart sound or jugular venous distension Points 11

MI in preceding 6 months Rhythm other than sinus or premature atrial contractions


More than 5 ventricular ectopic beats per min Abdominal, thoracic or aortic operation Age > 70 years Important aortic stenosis Emergency operation Poor condition as defined by any one of: PaO2 < 8 kPa PaO2 >6.5 kPa K+ < 3.0 mmol L-1 HCO3 < 20 mmol L-1 Urea > 7.5 mmol L-1 Creatinine > 270 mol L-1 SGOT abnormal Chronic liver disease Ass. Prof. Wail Khraise Total

10 7
7 3 5 3 4 3

53

April 2013 Slide 4

GOLDMANS INDEX OF CARDIAC RISK IN NON-CARDIAC PROCEDURES


0 5 points: major cardiac complication 0.3 3 % 6 12 points: major cardiac complication 1 10%

13 25 points: major cardiac complication 3 30%


26 53 points: major cardiac complication 19 75%

Ass. Prof. Wail Khraise

April 2013 Slide 5