2. Preop Eval Flashcards
goals
- ensure pt can tolerate anesthetic
- mitigate risk of complications
- reduce pt anxiety/educate pt
chart review
age
gender
surgical dx
previous hospitalizations
past medical history
co-existing diseases
meds/allergies
current meds
vitamins
herbal supplements
allergies
past surgical/anesthetic Hx
review past anesthetic records
- difficult IV
- difficult airway
- intraoperative hemodynamic instability
- respiratory issues
- PONV
Patient interview
- systematically question pt about each organ system
- use clinical judgement to det necessary depth of questions related to each organ system
- talk to pt at their education level
- engage at eye level
neurologic system
- current mental status
- seizures
- cardiovascular accident (CVA)
- stroke
- transient ischemic attack (TIA)
cardiac system
heart or vascular issues?
- stiff vessels: hypertension
- vessel blockage: CAD
- structural changes: septal defect
- electrical conduction: abnormal
coronary artery disease (CAD)
plaques build up in coronary arteries
resistance to flow
CAD evaluation
- any recent episodes of chest pain?
- do you have chest pain while performing activities?
- MET assessment
Metabolic Equivalents of Physical Activities
> = 4 METs is high risk for cardiovascular event during surgery
MET 1
eating
working at computer
dressing
MET 4
raking leaves
gardening
MET 5
Climbing 1 flight of stairs
dancing
bicycling
Revised cardiac risk index
(RCRI)
used to estimate pt level of risk for cardiac complications
RCRI factors
- High-risk surgery
- Ischemic heart disease
- H/O congestive heart failure
- H/O cerebrovascular disease
- diabete mellitus
- creatine >2.0mg/dL
High risk surgery
intraperitoneal
intrathoracic
supra-inguinal vascular
Hypertension evaluation
have you been diagnosed w/high blood pressure?
are you on blood pressure meds?
47% of americans
normal BP
<120/80 mmHg
elevated BP
120/80 - 129/80 mmHg
high BP stage 1
130/80 - 139/90 mmHg
high BP stage 2
> 140/90 mmHg
hypertensive crisis
> 180/120 mmHg
congestive heart failure
less than optimal ejection of blood from heart
= less blood to oxygenate tissues
CHF evaluation
shortness of breath w/activity?
more fatigued/weaker than normal?
swelling in legs?
persistent cough w/pink phlegm?
weight gain?
Valvular disease evaluation
diagnosed w/heart valve problem?
ascultate heart for murmurs
common valvular disorders
stenosis
regurgitation
stenosis
valve area narrowing restriction to flow
regurgitation
valve area does not close properly so blood flows back through valve
Atrial Septal Defect /
Ventricular Septal Defect
septum has not formed properly and has a hole
causes pressure changes
impacts blood flow direction in heart
Conduction System abnormalities
specialized cardiac cells allow electrical conduction
change conduction = change how heart pumps
HR 60-100
normal
HR < 60
bradycardia
HR > 60
tachycardia
bradycardia/tachycardia
may not supply heart w/enough O2
leads to ischemia
respiratory system common diseases
obstructive lung disease
restrictive lung disease
cigarette smoking/cessation
obstructive sleep apnea
Risk of postoperative pulmonary complications in pts w/respiratory diseases
risk is 1-23% after major surgery
PPC includes:
respiratory infection, resp failure, pleural effusion, atelectasis, pneymothorax, bronchospasm, apsiration pneymonitis
obstructive lung disease
asthma
COPD
* cant exhale as much as normal lung
dyspnea grade 0
no dyspnea while walking at normal pace
dyspnea grade I
short of breath when hurrying up hill
mild
dyspnea grade II
slower than contemporaries
moderate
dyspnea grade III
stops for breath after 100 yds
severe
dyspnea grade IV
dyspnea at rest
very severe
Cigarette smoking evaluation
always ask:
last cigarette?
how many years?
how many packs per day?id
ideal smoking cessation prior to surgery
6-8 weeks
less than 3-4 weeks doesn’t increase or decrease risk
ideal timeline to mx smoking cessation post surgery
4 weeks
reduces wound healing complications by 50%
obstructive sleep apnea (OSA)
short periods of apnea caused by blockage of air movement in upper airway
2-25% of population
Apnea Hypopnea Index
the combined average number of apneas and hypopneas that occur per hour of sleep
level of severity of OSA
AHI scoring system
Snoring
Tired
Observed apnea
Pressure (BP high)
BMI > 35
Neck > 16
Gender