Preoperative Risk Assessment, Cardiopulmonary Stratification, and Optimization of High-Risk Surgical Patients — WACS Viva & Clinical Scenarios (Pre-Op & Pain Clinic Rotation)

Exam-style preoperative risk assessment, cardiopulmonary stratification, and optimization of high-risk surgical patients viva scenarios with examiner probes…

Scenarios covered

• SCENARIO 1: A 68-year-old male with long-standing poorly controlled hypertension (BP 185/110 mmHg) and Type 2 diabetes mellitus presents to the pre-anaesthetic clinic scheduled for elective open right hemicolectomy for colon carcinoma in one week. He reports fatigue and dyspnoea when walking on level ground for 100 metres, with an estimated functional capacity of <4 METs. His resting ECG shows left ventricular hypertrophy with strain pattern and occasional unifocal ventricular premature contractions. How would you systematically stratify this patient's perioperative cardiopulmonary risk and optimize him b
• SCENARIO 2: A 62-year-old female with a history of non-ST elevation myocardial infarction (NSTEMI) treated medically 4 months ago presents for elective total abdominal hysterectomy for symptomatic uterine fibroids. She is currently asymptomatic on bisoprolol, ramipril, atorvastatin, and low-dose aspirin. Her room-air SpO₂ is 98% and blood pressure is 130/80 mmHg, but she cannot climb two flights of stairs without stopping. What is your structured approach to evaluating her cardiac readiness, timing of surgery, and perioperative medication management?
• SCENARIO 3: A 55-year-old male known to have severe asthma and severe mixed-pattern COPD is scheduled for major upper abdominal laparotomy for gastric adenocarcinoma. He has had two hospital admissions for acute exacerbations in the past 6 months, currently requires daily salbutamol rescue inhalers, and has an ARISCAT score calculated at 52. Outline your comprehensive pre-anaesthetic optimization protocol, including functional testing and perioperative strategies to minimize postoperative pulmonary complications.
• SCENARIO 4: A 74-year-old woman with severe symptomatic aortic stenosis (calculated aortic valve area 0.7 cm², mean transvalvular gradient 48 mmHg) presents with a bleeding caecal mass requiring urgent right hemicolectomy within 48 hours. Valve replacement is not immediately available at your centre. How do you assess, stratify, and formulate the anaesthetic and haemodynamic management plan for this patient?