3 - Outpatient Anesthesia Flashcards
An infant with a history of apnea and bradycardia must be asymptomatic for ________ before being considered a candidate for outpatient surgery
6 months
The greatest at risk age for developing SIDS is:
1 month to 1 year
Infants whose siblings died of SIDS are ________
5x more likely to die than the general population
If an infant is at risk for SIDS, when can they be considered for outpatient procedures?
6 months to 1 year old
Premature infants are NEVER candidates for outpatient anesthesia because (4)
- Anemic
- Lack fully developed gag reflex
- Immature temp control
- Immatue brainstem function, may develop resp compromise
Why is a Hct less than 30% concerning in a newborn?
May increase incidence of apnea
Postoperative apnea in infants may last as long as:
12 hours after surgery
Healthy former premature infants whose postgestational age is less than ________ should be admitted for monitoring
50-60 weeks
When are full term healthy infants not candidates for outpatient surgery? (3)
apneic episodes
FTT
feeding difficulties
Patient age exceeding ____ is predictive of hospital admission after outpatient surgery
80
When should surgeries be scheduled for patients with convulsive disorders?
early in the day
will need to be monitored for 4-8 hours post op
Patients with cystic fibrosis are at an increased risk for _____ and _____
GERD
pulm aspiration
Malignant hyperthermia susceptible patients have at least one of these 5 conditions:
- Previous episode of MH
- Masseter muscle rigidity with previous sx
- 1° relative with PMH of MH
- Mutations on chromosome 19
- Heat induced rhabdomyolysis
List 4 diseases caused by chromosome 19 mutation
central core myopathy
King-Denborough syndrome
Native American Myopathy
HypoPP
How many vials of dantrolene should an outpatient facility have?
36 required
Which patients with OSA or suspected OSA are candidates for ambulatory surgery?
Comorbid conditions optimized
able to use CPAP after discharge
OR
postop pain can be managed with nonopioid analgesics
Sickle cell patients must meet what criteria to be a candidate for ambulatory anesthesia? (5)
- no major organ disease 2/2 SCD
- no crisis in past year
- compliant with care
- live within 15 minutes of the facility
- close follow up care possible
Patients with sickle cell disease are likely to develop sickle crisis if ________ occur (3)
acidosis
hypoxia
hypovolemia
When should a patient with sickle cell be scheduled for surgery?
Early in the day
Needs preop hydration and prolonged postop monitoring
Which morbidly obese patients are not candidates for outpatient anesthesia?
those with significant comorbid conditions like
angina
asthma
uncontrolled OSA
A patient with an ASA > ____ is not a candidate for outpatient anesthesia
3-4
Patient evaluation should be within ______ hours for stable and ______ hours for high risk patients.
30
72
When should serum potassium levels be obtained?
For which patients?
within 7 days of surgery for patients receiving dig or diuretics
Who should have a preop BG?
patients with diabetes controlled with meds
How do nasal mucosa appear with an infectious URI?
Allergic Rhinitis?
Red and inflamed
ashen and boggy
After a Lower Respiratory Infection, bronchial reactivity may persist up to
6-8 weeks
List three H2 receptor antagonists
cimetidine
famotidine
ranitidine
List three gastric PPIs
Omeprazole
Pantoprozole
Which has a longer duration of action: omeprazole or ranitidine?
Omeprazole
Which inhalants are optimal for outpatient anesthesia?
desflurane and sevo
rapid on rapid off
When should IV fluids be used?
- Procedure > 30 min
- Increased risk of PONV
- Post op discomfort likely
- Prolonged fasting
- risk for bleeding
- antibiotics required
What are the most commons causes of hospitalization after outpatient surgery?
PONV and pain
When should oral intake be required prior to discharge?
when it’s crucial to convalescence at home
diabeteic patients
patients requiring post op PO meds
When is voiding mandatory before discharge?
history of postop retention
pelvic or urologic surgery
periop catheterization
Which is common in children: direct or indirect inguinal hernia?
99% are indirect
more common in premature infants, especially boys
60% of inguinal hernias occur on the ______ side
Right
An elective surgery on a child with a URI is acceptable if:
- no fever
- no lower respiratory symptoms
- No purulent discharge
- No altered behavior (loss of apettite, disinterested in play)
Which drug should be held preop: beta blocker or ace inhibitor?
Ace inhibitor. Most antihypertensives EXCEPT ACE/ARBs should be taken
Four drugs that can help with shivering
demerol
ketamine
clonidine
tramadol
In children, when are NSAIDs most effective?
When combined with pre-op rectal tylenol
For anxious patients, what anxiolytic regimen is recommended preop?
2-5mg versed per 70kg
Taken the night before and at 6AM on the morning of the surgery (regardless of when their surgery is)
For an anxious child in the preop holding area, what is the dose of oral versed?
0.25 mg/kg
Which local anesthetic can be problematic in ambulatory care thanks to its long duration?
Bupivicaine
Does bedrest reduce the likelihood of developing PDPH?
No
In fact early ambulation may help reduce risk
When are caudal blocks most frequently used?
Children with infraumbilical operations
used as a supplement for anesthesia and to reduce postop pain
What is the preferred induction agent for children?
Sevo
Smooth induction
fast on fast off
Six ways to reduce incidence of PONV
- Use regional alone if possible
- If general, use prop instead of gas
- Avoid nitrous
- minimize opioids
- Avoid paralytics
- Consider adequate hydration
Four predictors for PDNV
History of motion sickness
Previous PONV
Hx migraines
Pain upon discharge
What is the CTZ
chemotactic trigger zone
in medulla
How do versed and propofol affect PONV?
their antiemetic effects are longer lasting than their sedative effects
