008 Principles of Urologic Surgery - Perioperative Care

Question 1

One must always determine whether a woman in the childbearing years is pregnant before a surgical procedure. A __ is a simple method to do this.

Answer 1

One must always determine whether a woman in the childbearing years is pregnant before a surgical procedure. A URINE PREGNANCY TEST is a simple method to do this.

Question 2

The __ is a significant predictor of operative mortality.

Answer 2

The AMERICAN SOCIETY OF ANESTHESIOLOGISTS’ CLASSIFICATION is a significant predictor of operative mortality.

Question 3

Preoperative cardiac evaluation is meant to identify serious coronary artery disease, heart failure, symptomatic arrythmias, and the presence of a pacemaker or defibrillator. Major clinical predictors of cardiovascular risk are a __, __, __, __, __, and __.

Answer 3

Preoperative cardiac evaluation is meant to identify serious coronary artery disease, heart failure, symptomatic arrythmias, and the presence of a pacemaker or defibrillator. Major clinical predictors of cardiovascular risk are a RECENT MYOCARDIAL INFARCTION (WITHIN 1 MONTH), UNSTABLE ANGINA, EVIDENCE OF AN ISCHEMIC BURDEN, DECOMPENSATED HEART FAILURE, SIGNIFICANT ARRYTHMIAS, and SEVERE VALVULAR DISEASE.

Question 4

A patient’s ability to climb two flights of stairs is a good assessment of adequate __.

Answer 4

A patient’s ability to climb two flights of stairs is a good assessment of adequate FUNCTIONAL CAPACITY.

Question 5

Patients with an FEV1 of __ predicted are at high risk for complications.

Answer 5

Patients with an FEV1 of LESS THAN 30% predicted are at high risk for complications.

Question 6

Smoking must be discontinued at least __ before surgery to be effective in reducing risk.

Answer 6

Smoking must be discontinued at least 8 WEEKS before surgery to be effective in reducing risk.

Question 7

__ is associated with a reduced risk of death among high-risk patients undergoing major noncardiac surgical procedures. However, more recent data bring this into question.

Answer 7

PERIOPERATIVE BETA BLOCKADE is associated with a reduced risk of death among high-risk patients undergoing major noncardiac surgical procedures. However, more recent data bring this into question.

Question 8

Patients who have a depressed hypothalamic pituitary adrenal axis due to exogenous steroids should receive 50 to 100 mg of __ before the induction of anesthesia and 25 to 50 mg every 8 hours thereafter until the patient’s medication is resumed.

Answer 8

Patients who have a depressed hypothalamic pituitary adrenal axis due to exogenous steroids should receive 50 to 100 mg of INTRAVENOUS HYDROCORTISONE before the induction of anesthesia and 25 to 50 mg every 8 hours thereafter until the patient’s medication is resumed.

Question 9

In the elderly, __ can be the first clinical sign of hypoxia or of metabolic or infectious complications.

Answer 9

In the elderly, DELIRIUM can be the first clinical sign of hypoxia or of metabolic or infectious complications.

Question 10

In the pregnant patient, postoperative pain is best managed with __.

Answer 10

In the pregnant patient, postoperative pain is best managed with NARCOTIC ANALGESICS.

Question 11

A __ should be obtained in all patients older than 40 years and in those with a significant cardiac history.

Answer 11

A PREOPERATIVE ELECTROCARDIOGRAM should be obtained in all patients older than 40 years and in those with a significant cardiac history.

Question 12

It is important to remember that for __ and the use of __ before intestinal surgery, the studies are often based on data obtained from nonurologic patients, The urologist must consider this when the procedure being performed is significantly different from the standard general surgical operation on which the data are based. This is particularly true for bowel preparation, as urologic reconstructive procedures often require opening the isolated intestinal segment to be used in the procedure, exposing the entire contents to the operative field.

Answer 12

It is important to remember that for PROPHYLAXIS OF VENOUS THROMBOEMBOLIC DISEASE and the use of ANTIBIOTIC AND MECHANICAL BOWEL PREPS before intestinal surgery, the studies are often based on data obtained from nonurologic patients, The urologist must consider this when the procedure being performed is significantly different from the standard general surgical operation on which the data are based. This is particularly true for bowel preparation, as urologic reconstructive procedures often require opening the isolated intestinal segment to be used in the procedure, exposing the entire contents to the operative field.

Question 13

Parenteral antibiotics should be given within __ before intestinal surgery.

Answer 13

Parenteral antibiotics should be given within 60 MINUTES before intestinal surgery.

Question 14

__ inhalation anesthesia results in bowel distention.

Answer 14

NITROUS OXIDE inhalation anesthesia results in bowel distention.

Question 15

The half-life of warfarin is __, and it is recommended that warfarin be stopped __ before the surgical event.

Answer 15

The half-life of warfarin is 36 TO 42 HOURS, and it is recommended that warfarin be stopped 5 DAYS beofre the surgical event.

Question 16

__ and __ are irreversible inhibitors of platelet function and should be discontinued __ before surgery if bleeding risk is to be minimized.

Answer 16

ASPIRIN and CLOPIDOGREL are irreversible inhibitors of platelet function and should be discontinued 7 TO 10 DAYS before surgery if bleeding risk is to be minimized.

Question 17

For moderate- to high-risk groups on anticoagulation therapy, a therapeutic bridge is performed using __. These may be stopped 4 or 12 hours respectively, before the procedure and instituted shortly after its completion.

Answer 17

For moderate- to high-risk groups on anticoagulation therapy, a therapeutic bridge is performed using UNFRACTIONATED OR LOW-MOLECULAR-WEIGHT HEPARIN. These may be stopped 4 or 12 hours respectively, before the procedure and instituted shortly after its completion.

Question 18

The indications for fresh frozen plasma are __ and __.

Answer 18

The indications for fresh frozen plasma are IMMEDIATE REVERSAL OF WARFARIN and REPLACEMENT OF SPECIFIC CLOTTING FACTORS.

Question 19

The most common cause of transfusion-related fatality is __.

Answer 19

The most common cause of transfusion-related fatality is TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI).

Question 20

__ results in increased blood loss and an increased incidence of wound infection.

Answer 20

HYPOTHERMIA results in increased blood loss and an increased incidence of wound infection.

Question 21

If hair is to be removed, it should preferable be removed immediately before the surgical event with __.

Answer 21

If hair is to be removed, it should preferable be removed immediately before the surgical event with MECHANICAL CLIPPERS.

Question 22

The need for postoperative parenteral nutrition should be anticipated in patients undergoing major urologic procedures involving the use of bowel. If it is likely the patient will not be able to take an adequate caloric intake orally by __, postoperatively parenteral nutrition should be instituted.

Answer 22

The need for postoperative parenteral nutrition should be anticipated in patients undergoing major urologic procedures involving the use of bowel. If it is likely the patient will not be able to take an adequate caloric intake orally by 7 TO 10 DAYS, postoperatively parenteral nutrition should be instituted.

Question 23

The __ represents the least anesthetic risk to the mother and fetus with regard to spontaneous abortion and teratogenicity.

Answer 23

The SECOND TRIMESTER represents the least anesthetic risk to the mother and fetus with regard to spontaneous abortion and teratogenicity.

Question 24

Severely malnourished patients (>20 lbs weight loss in 3 months) significantly benefit 7 to 10 days of __ feedings before elective surgery.

Answer 24

Severely malnourished patients (>20 lbs weight loss in 3 months) significantly benefit 7 to 10 days of ENTERAL feedings before elective surgery.

Question 25

In a patient with renal insufficiency, __ is a better choice than low-molecular-weight heparin.

Answer 25

In a patient with renal insufficiency, UNFRACTIONATED HEPARIN is a better choice than low-molecular-weight heparin.