PS07 2017: 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 stuff we are supposed to know:

·         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

·      Before the day of surgery preferable if:

o  Major surgery

o  Major comorbidities

o  Major anaesthetic or analgesic concerns

·      If on day of surgery:

o  System must allocate time for it

·      Last minute acceptable if:

o  Labour epidural

o  Emergency surgery: patient in A&E or ICU

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, anaes/surg/med Hx

·      Ex: airway + resp + cvs

·      Ix: PRN

·      Retrieve information from elsewhere PRN

·      Advance care directive PRN

Optimisation

·      Investigations

·      Treatment

·      Referrals

Plan/discussion/consent

·      Go ahead vs postpone vs cancel

·      Anaesthesia/sedation + procedures + analgesic plan + blood

·      Financial consent

·      Limits of care PRN

·      Instructions for medications + fasting + smoking

·      Must provide information (+/- interpreter)

·      Must allow for questions

 

Fasting times for healthy patients:

Children <6/12

Clear fluid 3mL/kg/h 1 hour

Breast milk 3 hours

Formula 4 hours

Children >6/12

Clear fluid 3mL/kg/h 1 hour

All else 6 hours

Adults

Clear fluid 400mL 2 hours

All else 6 hours

(above times don’t apply if in labour, trauma, upper GI pathology etc)

 

Fasting: additional info:

Medications

2 hours with sip of clear fluid unless specified

Prokinetics and antacids

Consider giving if at risk of aspiration

Clear fluid examples

Water

Lolly water

Pulp free juiceB

Black tea and coffee

Chewing gum

More a foreign body risk than a gastric secretagogue!

Food

6h for “limited solid food”

Presumably longer for Hofbrauhaus challenge

 

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