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OMC V, Module II > 2. Preanesthetic Patient Evaluation and Risk Assessment > Flashcards

2. Preanesthetic Patient Evaluation and Risk Assessment Flashcards

1
Q

Practice Advisory for Preanesthesia Evaluation: A Report by the American S Anesthesiology

  • The appointed task force of 12 members were charged to:
  • 1) review ____ evidence
  • 2) obtain expert and public consensus ____
  • 3) create a ____-based assessment of currently available scientific literature and opinion
  • They concluded that controlled studies for such evaluations were ____.
  • 11% (47 of 6271) of reports identified inadequate or incorrect pre-operative assessment that accounted for 3.1% (197) of adverse events.
A

published
option
consensus
lacking

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2
Q

Benefits
• Increases the likelihood of patient and physician ____
• Decreases the likelihood of ____
• Reduces health care ____

A

satisfaction
adverse events
costs

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3
Q

Risk Factors

  • Patient’s ____ status
  • Non-____, poorly stabilized cardiac and pulmonary
  • ____
  • Age > ____ years
  • ____ infants
  • Surgery
  • ____
  • Type of facility
A 
clinical
non-compensated
obstructive sleep apnea
85
pre-term

anesthesia

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4
Q 
Components
• Evaluation of pertinent medical \_\_\_\_
• Patient \_\_\_\_
• Physical \_\_\_\_
• \_\_\_\_
• \_\_\_\_
A 
records
interview
examination
consultations
consent
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5
Q
  • No ____ trials of the clinical impact of performing a preanesthesia medical records review or physical examination were found.
  • Several studies reported specific perioperative outcomes occurring in patients with specific pre- existing conditions.
A

controlled

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6
Q

• In terms of timing of this preanesthetic interview and physical exam
◦ Wouldn’t wanna do this prior to the day of surgery
◦ Ideally want to do this eval ____ days before surgery
◦ The less severe the pt’s disease, the less time you need to allow between the
preanesthetic eval and the actual procedure

A

several

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7
Q 
Patient Interview
• Abnormalities of the major \_\_\_\_ systems
• Current medications
• Drug \_\_\_\_
• Social history
• \_\_\_\_ history
• Pregnancy
• Previous \_\_\_\_
A

organ
allergies
family
anesthesia

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8
Q

Review of cardiovascular system: diseases

  • ____ abnormalities
  • CAD
  • Previous ____
  • Valvular disorders
  • ____
  • Arrhythmias
  • ____
  • Previous cardiac surgery
A

BP
MI
CHF
cardiomyopathy

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9
Q

Review of cardiovascular system: symptoms

  • ____
  • Dyspnea
  • ____
  • Orthopnea
  • ____
  • Palpitations
A

angina
syncope
PND

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10
Q 
Goldman Cardiac Risk Index
• 1n 1977, published study1
• Reports \_\_\_\_ outcome
• Does not diagnose \_\_\_\_ disease
• Assign point values to \_\_\_\_ variables
• Predictive value is \_\_\_\_
A

peri-operative
cardiac
independent
limited

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11
Q

• Just know there are various points assigned to different parts of the pt’s ____ and
____

A

history

physical exam

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12
Q

Incidence of perioperative reinfarction following a myocardial infarction (MI)

Time since MI (months)

0-3
____%

4-6
____%

7-12
____%

13-24
____%

> 24
____%

A 
30
13
5.5
4.2
4.1
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13
Q

Time interval from myocardial infarction (MI) as a predictor of surgical risk

< 6 mos post-MI
____% overall mortality

6-9 mos post-MI
____% overall mortality

> 12 mos post-MI
____% overally mortality

A

18-22
10
5

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14
Q

Valvular Disease

• ____ has the highest perioperative morbidity and mortality of all the valvular diseases

A

aortic stenosis

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15
Q

• This is a topic that we have to face when we’re doing dentistry on pts and the issue is ____ and prevention of this in pts that have certain things in their history that may predispose them to this after they get some sort of dental procedure that will elicit bleeding, a bacteremia can occur

A

acute bacterial endocarditis

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16
Q

• They looked at different antibiotic regimens that have been used and how we’ve changed this over time
• Prior to these latest recommendations, pts were given antibiotics before AND after the procedures
◦ Now we give only ____ hour before the procedure
◦ Eliminated giving them a ____ dose ____ hours after the procedure ◦ That was the major change that took place

A

1
second
6

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17
Q

All dental procedures that involve manipulation of gingival tissue or periapical region of teeth or perforation of the oral mucosa

following DO NOT need prophylaxis: routine ____ injections through noninfected tissue, taking dental ____, placement of removable ____ or orthodontic appliances, adjustment of ____ appliances, placement of orthodontic ____, shedding of ____ teeth, and bleeding from ____ to the lips or oral mucosa

A 
anesthetic
radiographs
prosthodontic
orthodontic
brackets
deciduous
trauma
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18
Q

AHA’s Conclusions

  • Recommend that most patients no longer need short-term antibiotics as a ____ measure
  • Risks associated with taking preventive antibiotics outweigh the ____ for most patients
  • No compelling evidence that antibiotics prior to a surgical procedure prevents ____
  • Maintenance of optimal oral ____ is more important than prophylactic antibiotics for dental procedures to reduce the risk of infective endocarditis.
A

preventive
benefits
endocarditis
health

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19
Q

Who should get prophylactic antibiotics

  • ____ cardiac valves
  • A history of ____
  • Cardiac ____ recipient
  • Congenital heart disease
  • ____ cyanotic congenital heart disease, including those with palliative shunts and conduits
  • a completely ____ congenital heart defect with ____ material or device, whether placed by surgery or by catheter, during the first ____ months after the procedure
  • any repaired congenital heart disease with ____ defect at the site or adjacent to the site of a prosthetic patch or device
A

prosthetic
endocarditis
transplant

unrepaired
repaired
prosthetic
six
residual
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20
Q

Antibiotic Regiments

ORAL
Adults: ____
Children: ____

IV/IM
Adults: ____, ____, ____
Children: ____, ____, ____

Pen-allergic
Adults: ____, ____, ____
Children: ____, ____, ____

A

amoxicillin 2 gm
50 mg/kg

ampicillin 1 gm
cefazolin 1 gm
ceftriaxone 1 gm

50 mg/kg
50 mg/kg
50 mg/kg

clindamycin 600 mg
azithromycin 500 mg
clarithromycin 500 mg

20 mg/kg
15 mg/kg
15 mg/kg

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21
Q 
Review of Respiratory System:
Diseases
 • \_\_\_\_
• COPD
• Recent \_\_\_\_
• Pneumonia
• \_\_\_\_
A

asthma
URI
cystic fibrosis

22
Q 
Review of Respiratory System:
Symptoms
• \_\_\_\_
• Wheezing
• \_\_\_\_
• Sputum production
• \_\_\_\_
A

dyspnea
cough
hemoptysis

23
Q

Postoperative pulmonary complications

  • ____
  • Pneumonia
  • Exacerbation of ____ disease
  • Respiratory failure
A

atelectasis

chronic

24
Q

URI and Anesthesia

• Patients with URI should postpone surgery for ____ weeks.

25
Q

Smoking and anesthesia: Preoperative abstinence and perioperative morbidity

  • Determined a ____ within which discontinuing smoking can decrease morbidity and mortality.
  • Abstinence for ____ weeks improves ciliary function and decreases sputum production
A

time frame

4 to 8

26
Q

Review of Nervous System:
Diseases

  • ____
  • TIA
  • ____ disorder
  • Multiple sclerosis
  • ____ disease
  • Developmental delay
  • ____ injury
A

CVA
seizure
parkinson’s
spinal cord

27
Q 
Review of Nervous System:
Symptoms
• \_\_\_\_
• Headaches
• \_\_\_\_
• Weakness
• \_\_\_\_ problems
A

dizziness
seizures
memory

28
Q

Neurologic Risk Assessment
• 0.7% stroke rate in 735 patients undergoing ____ surgery.7
• Patients with ____ are at high risk of stroke, and their risk may be stratified by clinical scale, ____ imaging, and diffusion magnetic resonance imaging.8
• A history of ____ or ____ is a strong predictor of increased cardiac mortality.8

A 
non-cardiac
TIA's
vessel
CVA
TIA
29
Q 
Review of Endocrine System:
Diseases
 • \_\_\_\_
• Thyroid gland dysfunction
• \_\_\_\_ gland dysfunction
A

diabetes

adrenal

30
Q

American Society of Anesthesiology Classification of Physical Status (ASA)

  • In 1940 - 41, ASA asked a committee of three physicians (Meyer Saklad, M.D., Emery Rovenstine, M.D., and Ivan Taylor, M.D.).
  • This effort was the first by any medical specialty to stratify ____ for its patients.
  • Classified patients in relation to their ____ only.
  • Published in 1963.
A

risk

physical status

31
Q

ASA GRADE

1
Status: ____ patient
Absolute mortality: ____%

2
Status: ____ systemic disease, or patient over ____ years old
Absolute mortality: ____%

3
Status: systemic disease taht causes definite functional ____ on life
Absolute mortality: ____%

4
Status: ____ systemic disease that is a constant threat to life
Absolute mortality: ____%

5
Status: morbound patient unlikely to survive ____ hours without surgery
Absolute mortality: ____%

A 
normal healthy
0.1
mild
80
0.2
limitation
1.8
severe
7.8
24
9.4
32
Q 
Physical Examination
• \_\_\_\_ signs
• General inspection
• \_\_\_\_ of the heart and lungs
• Evaluation of the airway
A

vital

auscultation

33
Q

Airway Assessment

  • ____
  • Short neck
  • Limited ____ extension
  • Decreased thyromental distance
  • ____ disease or trauma
  • ____ trauma
  • Craniofacial syndromes
  • ____
  • Trismus
  • ____
  • Enlarged tonsils
A

habitus
neck
cervical spine

facial
retrognathia
tumors

34
Q 
Predictors of difficult intubation
• Obesity - BMI > \_\_\_\_
• MIO < \_\_\_\_ mm
• \_\_\_\_, \_\_\_\_ occlusion
• \_\_\_\_ distance
A 
30
40
retrognathia
class II
thyromental
35
Q

Modified Mallampati Classification8

  • Standing or sitting ____
  • ____ mouth and tongue out
  • Grouped according to visualized structures

• Class1/Grade1= We can see ____, we can see the tonsils, nice open airway, we can see the palatine fossae, the uvula, the soft palate perfectly
• Class2/Grade2= Start to see less of an open ____
◦ Only see part of the uvula, can still see soft palate/palatine fossae
• Class3=See less
◦ Don’t see ____, we do see the ____ (that’s the dotted line) ◦ The ____ is obstructing the uvula
• Class4 = don’t even see the ____ anymore
◦ All we see if ____ when we look back at those pts

A 
upright
open
everything
airway
uvula
soft palate
tongue
soft palate
hard palate
36
Q

• Mallampati Classes ____ and ____ pose an increased risk of loss of a patent airway during ____ and ____ sedation.

A

III
IV

moderate
deep

37
Q

Preoperative Tests

____ or identification of a disease or disorder that may affect perioperative anesthesia care

____ or assessment of an already known disease, disorder, or medical therapy that may affect perioperative anesthesia care

Formulation of specific
____ and alternative for perioperative anesthesia care

A

discovery
verificiation
plan

38
Q

Labs and diagnostic studies

  • ____
  • BMP
  • ____ studies
  • LFT’s
  • ____
  • Beta-HCG
  • ____
  • Echocardiogram
  • ____ test
  • Cardiac catheterization
  • ____ duplex
  • CXR
  • ____
  • ABG
A

CBC
coagulation
TFT’s

ECG
stress
carotid
PFT’s

39
Q

Routine electrocardiographic findings were reported as abnormal in ____% of cases and led to changes in clinical management of ____% of the cases found to be abnormal.

• Routine chest x-ray findings were reported as abnormal in ____% of cases (n = 20 studies) and led to changes in clinical management in ____% of the cases found to be abnormal.

A
  1. 0-42.7
  2. 1

2.5-60.1
0-51

40
Q

Pre-anesthesia pregnancy testing for all women patients of childbearing age
• ____ or elective
• ____ and when to test
• ____ to test

A

mandatory
how
whom

41
Q

Pregnancy Testing
The incidence of newly diagnosed pregnancies on the day of surgery is ~ ____%
The average cost of a urine pregnancy test is ~ $____ and a serum pregnancy test is ~ $____.
Serum Beta-hCG is elevated in pregnancy, ____ tumors, testicular cancer, ____, and hepatobiliary tumors.

Quantitative serum Beta-hCG levels and pregnancy:
3 weeks since LMP: 5 - 50 mIU/ml
4 weeks since LMP: 5 - 426 mIU/ml
5 weeks since LMP: 18 - 7,340 mIU/ml
6 weeks since LMP: 1,080 - 56,500 mIU/ml
7 – 8 weeks since LMP: 7,650 - 229,000 mIU/ml
9 – 12 weeks since LMP: 25,700 - 288,000 mIU/ml 13 – 16 weeks since LMP: 13,300 - 254,000 mIU/ml 17 – 24 weeks since LMP: 4,060 - 165,400 mIU/ml 25 – 40 weeks since LMP: 3,640 - 117,000 mIU/ml

A 
0.3-2.2
10-15
75
ovarian germ cell
teratomas
42
Q

HUP Policy

TAKE A LOOK AT THIS!

A

need an updated slide

43
Q

Determination of Medical risk

Can tolerate the proposed anesthetic both ____ and psychologically

More ____ is needed

____ risk is associated with the proposed treatment in the patient’s current physical or emotional state

A

physically
information
excessive

44
Q

Instructions

  • NPO (____ hours)
  • ____ of meds
  • ____ of meds
  • ____
A

8
continuation
alteration
escort

45
Q 
Aspiration Risk
• \_\_\_\_
• Recent food intake
• \_\_\_\_
• Gastroparesis
• \_\_\_\_ obstruction
A

obesity
GERD
GI

46
Q

Guidelines to reduce risk of pulmonary aspiration

No ____

Routine use of gastric stimulants and anti-emetics is ____

Ingested material
clear liquids
min fasting period: ____

light meal
min fasting period: ____

A

food or drink
not recommended

2 hours
6 hours

47
Q 
Preoperative medication considerations
• \_\_\_\_
• Steroids
• \_\_\_\_
• Anticoagulants
• Antibiotic \_\_\_\_
• Transfusions
A

diuretics
insulin
prophylaxis

48
Q 
Consent
• Discussion about the proposed \_\_\_\_ technique
• \_\_\_\_ and risks
• Anesthetic \_\_\_\_
• Easily understood \_\_\_\_
A

anesthetic
benefits
alternatives
language

49
Q

The following remarks represent a synthesis of the opinion surveys, literature and Task Force consensus:

  1. Content of the preanesthesia evaluation includes but is not limited to (1) readily ____ medical records, (2) patient ____, (3) a directed
  2. Timing of the preanesthesia evaluation can be guided by considering combinations of surgical ____ and severity of disease, a
  3. Routine preoperative tests (i.e., tests intended to dis- cover a disease or disorder in an asymptomatic pa- tient) do ____ make an important contributi
  4. Selective preoperative tests (i.e., tests ordered after consideration of specific information obtained from sources such as medical records, patient int
  5. Decision-making parameters for specific preopera- tive tests or for the timing of preoperative tests can- not be unequivocally determined
A

accessible
interview

invasiveness

not

50
Q

QUIZ QUESTIONS:

  1. What cardiac valvular condition is associated with the highest morbidity and mortality?
    a. ____
  2. T/F: Pts with modified Mallampati 3/4 pose an increased risk to airway problems during anesthesia?
    a. ____
A

aortic stenosis

true

OMC V, Module II (9 decks)

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