PS07 2021: Pre-anaesthesia consult

 

List:

·        General comments

·        Legal

·        Circumstances

·        Contents

·        Fasting times

·        Fasting: additional info

 

General comments:

·        Consult = assessment + optimization + plan + discussion + consent

·        Consult must not be omitted except in a dire emergency

·        Consult must be documented at the time

·        The treating anaesthetist cannot take questionnaires at face value

·        The treating anaesthetist cannot take a colleague’s consult at face value

 

Legal resources:

·        Good Medical Practice: A Code of Conduct for Doctors in Australia

·        Privacy Act 1998

·        Privacy Amendment Act 2000

·        Supporting Anaesthetists Professionalism and Performance: A Guide for Clinicians

 

Circumstances:

Timing

·      Beforehand: major surgery, painful surgery, comorbidities

·      Same day: most operations

·      Last minute: labour epidural, emergency operation

Location

·      Ideally a single room

·      Anaesthetic room acceptable if

o  Prior phone consult

o  Emergency surgery

o  Patient being assessed is not left alone

o  Patient currently on the table is not left alone

·      Attend to privacy and dignity

 

Contents:

Assessment

·      Basics: patient identity and surgery

·      Setting: facilities + staffing + equipment for entire stay

·      Hx: HOPC, PMHx (anaes/surg/med)

·      Ex: vital signs + A + B + C

·      Ix: as needed

·      Retrieve external info PRN

·      Advance care directive PRN

Optimisation

·      Investigations

·      Treatment

·      Referrals

Planning

·      Go ahead vs postpone vs cancel

·      Anaesthetic + procedures + analgesic + blood

·      Financial consent

·      Limits of care PRN

·      Instructions for medications + fasting + smoking

·      Must provide interpreter if NESB

·      Must allow for questions

 

Fasting times:

Children <6/12

·      Clear fluid 3mL/kg/h until 1 hour

·      Breast milk 3 hours

·      Formula 4 hours

Children >6/12

·      Clear fluid 3mL/kg/h until 1 hour

·      All else 6 hours

Adults

·      Clear fluid 400mL 2 hours

·      All else 6 hours

 

Fasting: additional info

Delayed emptying

*consider prokinetic and/or antacid*

·      Labour

·      Trauma

·      Opioid

·      Upper GI pathology

Clear fluids

·      Water

·      Lolly water

·      Pulp free juice

·      Black tea and coffee

Other

·      6h for “limited solid food” cf. Hofbrauhaus challenge

·      Medications + sip of fluid until 2 hours

·      Chewing gum: foreign body > gastric secretagogue

 

Breastfeeding:

https://ketaminenightmares.com/fex/classics/periop/obstetrics_breastfeeding_analgesia.htm

 

 

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