Anaesthesia for Emergency Surgical Procedures

Clinical Description

Optimization of patients for anaesthesia is a dynamic process. In extreme emergencies it may not be possible to stabilize a patient fully before theater but the process must be instigated

Ingested material Minimum fasting period

Clear liquids 2h (1 hour in children)

Breast milk 4h

Infant formula 6h

Solids 6h immediately on admission, to allow the best chance of a good outcome for the patient. This is multidisplinary decision of weighing risk vs benefit and managing clinicians and anaesthetists must work together

Septic hypotensive patients must be resuscitated and source isolation surgery commenced within 12 hours of admission.

ALL patients requiring resuscitation should have 2 wide bore (18G or larger for adults) placed and rapid infusion of isotonic fluids commenced immediately. A urinary catheter must also be placed. Close monitoring of these patients is paramount.

Uncontrolled haemmorhage is an indication for surgery with or without the availability of blood. All efforts should be made to make blood available.

If patient requires referral, ensure patient is stable to survive transfer. LIFE SAVING SURGERY (eg stopping bleeding/ delivery of eclamptic) SHOULD BE PERFORMED PRIOR TO REFFERAL.

INVESTIGATIONS PRIOR TO SURGERY

Minor Surgery (excision, biopsy, suturing, MUA, I&D)

ASA1 ASA2 ASA3

FBC N/A N/A N/A

Clotting N/A N/A

U&E/kidney function

N/A N/A

ECG N/A N/A Consider if no ECG in past 12 months

CXR N/A N/A

Intermediate (hernia, knee arthroscopy, tonsillectomy, adenoidectomy)

ASA1 ASA2 ASA3

FBC N/A N/A Yes

Clotting N/A Consider in patients with chronic liver dzz and taking anticoagulants

U&E N/A Consider in patients at risk of AKI

Yes

ECG N/A Consider for people with cardiovascular, renal or diabetes comorbidities yes

CXR N/A n/a consult

Major (laparatomy, c/s, thoracotomy)

ASA1 ASA2 ASA3

FBC yes yes Yes

Clotting n/a Consider in patients with chronic liver disease

Consider in patients with chronic liver disease

U&E &CR (Renal

Function)

Consider in patients at risk of AKI yes Yes

ECG n/a Consider in patients with heart disease and HTN

Consider in patients with heart disease and HTN

CXR yes Yes (pts with heart disease, htn, chest disease)