Lesson 1Interpreting functional capacity and exercise tolerance in perioperative riskExplains how to evaluate functional capacity using METs, exercise tolerance, and symptom-limited activity, and how these findings influence perioperative cardiac and pulmonary risk, testing decisions, and level of postoperative monitoring for patients in our settings.
Metabolic equivalents and activity examplesAssessing exercise tolerance by patient interviewLinking poor capacity to cardiac riskWhen low METs prompt further cardiac testingImpact on postoperative monitoring levelLesson 2Assessment and management of obstructive sleep apnoea and CPAP use preoperativelyFocuses on screening for obstructive sleep apnoea, interpretation of STOP-Bang, perioperative risks, and management of patients using CPAP, including device verification, postoperative monitoring, and opioid-sparing strategies suitable for local resources.
STOP-Bang and other OSA screening toolsPerioperative risks of untreated OSACoordinating patient-owned CPAP devicesPostoperative monitoring and positioningOpioid-sparing and sedation precautionsLesson 3Laboratory and additional testing decisions: when to request ECG, troponin, chest x-ray, echo, stress testing, and when to deferClarifies when preoperative tests such as ECG, troponin, chest x-ray, echocardiography, and stress testing are indicated, how to avoid unnecessary testing, and when to defer or cancel surgery based on abnormal or missing results in resource-limited environments.
Evidence-based indications for preop ECGRole of troponin and cardiac biomarkersWhen chest x-ray or pulmonary tests are neededIndications for echo and stress testingChoosing to defer or cancel for safetyLesson 4Evaluation of diabetes, glycaemic targets, and perioperative glucose testingCovers evaluation of diabetes type, control, and complications, setting perioperative glycaemic targets, and planning glucose monitoring, insulin and oral agent adjustments, and treatment of hypo- and hyperglycaemia around surgery in Ugandan patients.
Assessing diabetes type, duration, and controlPerioperative blood glucose targets and rangesAdjusting basal and bolus insulin regimensManaging oral hypoglycemics on surgery dayProtocols for hypo- and hyperglycemia treatmentLesson 5Renal function assessment and implications of mild creatinine elevationAddresses assessment of renal function using creatinine, eGFR, and urine output, with emphasis on mild creatinine elevation, its causes, and implications for drug dosing, fluid management, and contrast or nephrotoxin exposure in local contexts.
Interpreting creatinine and estimated GFRRecognizing early chronic kidney diseaseDrug dosing adjustments in renal impairmentFluid strategy in patients with renal riskAvoiding perioperative nephrotoxic exposuresLesson 6Medication reconciliation: antiplatelets, beta-blockers, ACE inhibitors, statins, oral hypoglycemics and perioperative management principlesDetails systematic medication reconciliation, focusing on antiplatelets, beta-blockers, ACE inhibitors, statins, and oral hypoglycemics, with timing of continuation or holding, bridging strategies, and documentation of shared decisions for Ugandan healthcare.
Verifying medication lists and adherencePerioperative management of antiplatelet agentsBeta-blockers, ACE inhibitors, and ARBs strategyStatins and other cardioprotective medicationsOral hypoglycemics and insulin adjustmentLesson 7Cardiac risk assessment: Revised Cardiac Risk Index, ACS NSQIP predictors, and application to CAD with stentExplores major cardiac risk indices, interpretation of RCRI and ACS NSQIP, and their application to patients with coronary artery disease and stents, guiding timing of surgery, monitoring, and perioperative cardiology consultation in our facilities.
Revised Cardiac Risk Index componentsUsing ACS NSQIP surgical risk calculatorsRisk categories and perioperative event predictionManagement of bare-metal and drug-eluting stentsIndications for cardiology consult or stress testingLesson 8Focused history and systems review for cardiovascular, respiratory, endocrine, and airway risksCovers targeted history and review of systems to identify cardiovascular, respiratory, endocrine, and airway risks, emphasizing red flags, functional status, prior anaesthesia issues, and documentation that supports safe anaesthetic planning in Uganda.
Key cardiovascular history and red flag symptomsRespiratory history, smoking, and dyspnea assessmentEndocrine history with focus on diabetes and thyroidPrior anesthesia complications and family historyStructured airway history and symptom screeningLesson 9Airway assessment tools (Mallampati, neck mobility, mouth opening) and predicting a difficult airwayReviews bedside airway assessment tools, including Mallampati class, mouth opening, thyromental distance, and neck mobility, and integrates findings into prediction of difficult mask ventilation, intubation, and planning for backup strategies locally.
Mallampati classification technique and limitsMouth opening, thyromental distance, and dentitionNeck mobility and cervical spine considerationsPredictors of difficult mask ventilationFormulating a difficult airway backup plan
