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Iraqi Board Anesthesia study materials
Iraqi Board Anesthesia study resources

Iraqi Board Anesthesia: Preoperative Assessment, Risk Stratification and Optimization

Iraqi Board Anesthesia · Work through your exam, one topic at a time.

All guide sections

Preoperative Assessment, Risk Stratification and Optimization

These items ask you to grade risk with a validated tool and then change management. The exam favours ASA physical status, the Revised Cardiac Risk Index (RCRI), ARISCAT and STOP-BANG, plus specific optimisation rules.

Risk tools

  • ASA I–VI with suffix E for emergency; ASA III is severe systemic disease, not mild disease - learn the current wording precisely.
  • RCRI: six predictors - high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 177 µmol/L. Three or more predicts about 11% major cardiac events.
  • ARISCAT estimates postoperative pulmonary complications; STOP-BANG of 5 or more means high OSA risk with planned postoperative monitoring.

Optimisation rules that appear in exams

  • Anaemia: investigate and treat before elective surgery; restrictive transfusion threshold 7 g/dL (8 g/dL in cardiac and some orthopaedic protocols).
  • Smoking: cessation of at least 4 weeks reduces pulmonary complications.
  • Diabetes: proceed if HbA1c below 8.5%; hold SGLT2 inhibitors 3–4 days to avoid euglycaemic ketoacidosis; continue metformin.
  • Fasting: 2 hours clear fluids, 4 hours breast milk, 6 hours light meal; no routine prolonged starvation.
  • Antithrombotics: aspirin usually continued for secondary prevention; DOACs held around 48 hours (longer with renal impairment); neuraxial blocks follow ASRA intervals.

Worked example

A 68-year-old with Hb 9.2 g/dL, eGFR 40, insulin-treated diabetes, infarction 2 years ago, listed for open colectomy. RCRI = 3 (high-risk surgery, ischaemic heart disease, insulin-treated diabetes), predicting about 11% major adverse cardiac events. Plan: treat anaemia, continue the beta-blocker, avoid intraoperative hypotension, arrange high-dependency care and troponin surveillance. Do not cancel on the score alone - modify the plan.

Traps

Applying the RCRI to emergency surgery, where it is not validated; ordering a battery of routine tests instead of targeted ones; forgetting that the E suffix changes ASA but not RCRI.