2. Preanesthetic Patient Evaluation and Risk Assessment Flashcards
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.
published
option
consensus
lacking
Benefits
• Increases the likelihood of patient and physician ____
• Decreases the likelihood of ____
• Reduces health care ____
satisfaction
adverse events
costs
Risk Factors
- Patient’s ____ status
- Non-____, poorly stabilized cardiac and pulmonary
- ____
- Age > ____ years
- ____ infants
- Surgery
- ____
- Type of facility
clinical non-compensated obstructive sleep apnea 85 pre-term
anesthesia
Components • Evaluation of pertinent medical \_\_\_\_ • Patient \_\_\_\_ • Physical \_\_\_\_ • \_\_\_\_ • \_\_\_\_
records interview examination consultations consent
- 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.
controlled
• 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
several
Patient Interview • Abnormalities of the major \_\_\_\_ systems • Current medications • Drug \_\_\_\_ • Social history • \_\_\_\_ history • Pregnancy • Previous \_\_\_\_
organ
allergies
family
anesthesia
Review of cardiovascular system: diseases
- ____ abnormalities
- CAD
- Previous ____
- Valvular disorders
- ____
- Arrhythmias
- ____
- Previous cardiac surgery
BP
MI
CHF
cardiomyopathy
Review of cardiovascular system: symptoms
- ____
- Dyspnea
- ____
- Orthopnea
- ____
- Palpitations
angina
syncope
PND
Goldman Cardiac Risk Index • 1n 1977, published study1 • Reports \_\_\_\_ outcome • Does not diagnose \_\_\_\_ disease • Assign point values to \_\_\_\_ variables • Predictive value is \_\_\_\_
peri-operative
cardiac
independent
limited
• Just know there are various points assigned to different parts of the pt’s ____ and
____
history
physical exam
Incidence of perioperative reinfarction following a myocardial infarction (MI)
Time since MI (months)
0-3
____%
4-6
____%
7-12
____%
13-24
____%
> 24
____%
30 13 5.5 4.2 4.1
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
18-22
10
5
Valvular Disease
• ____ has the highest perioperative morbidity and mortality of all the valvular diseases
aortic stenosis
• 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
acute bacterial endocarditis
• 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
1
second
6
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
anesthetic radiographs prosthodontic orthodontic brackets deciduous trauma
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.
preventive
benefits
endocarditis
health
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
prosthetic
endocarditis
transplant
unrepaired repaired prosthetic six residual
Antibiotic Regiments
ORAL
Adults: ____
Children: ____
IV/IM
Adults: ____, ____, ____
Children: ____, ____, ____
Pen-allergic
Adults: ____, ____, ____
Children: ____, ____, ____
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
