3 Pre-Operative Assessment Flashcards
What is Anesthesia
reversible, drug induced depression of central nervous system –> loss of response and perception of all external stimuli
Billing Terms for Anesthesia
General
Regional
MAC
Components of Anesthetic State
unconsciousness amnesia analgesia immobility *not all applicable to regional or MAC
General Chart Review
Hx: medical, surgical, social, anesthesia (MH, PONV)
ETOH, meds, labs, tests
Should airway assessment be done with EVERY case?
yes
Airway Assessment
mallampati
thyromental distance
Musculoskeletal Hx
Chronic Diseases
Surgical Hx
Neurological Hx
Hx stroke, seizure, MS, parkinsons
-document pre-existing injuries
Cardiovascular Hx
- HTN
- Ischemic Heart Dx/ LV dysfunction
- Valvular Dx
- Arrhythmias
- need atleast 4 METS
HTN
sys >140
dia >90
**tend to drop pressure more during induction - pre-load IVF
-maintain w/i 20% of baseline
Angina/ MI
unstable places pt at risk for MI r/t stress of anesthesia
Stents
plavix, coumadin or other antiplatelets?
LVD
Left Ventricular Dysfunction
> Morbidity
Defined as EF < 50%
Aortic Stenosis
- greatest risk for non-cardiac surgery MI
- delay elective until further testing can be done
Beta-Blockers
- make sure it is received
- if not given, give in OR
- reduces risk of peri-operative ischemia
Asthma
- factors, severity & frequency
- inhalers - pt brings own
Smoking
increase risk of pulmonary complications
Acute effects of nicotine
increase HR
increase myocardial demand
increase b/p
OSA
-bring pt CPAP
-no deep extubations
-cont. pulse ox for 24 hrs post op
STOP BANG
Small Bowel Obstruction
high risk for aspiration - RSI
Mendelson Syndrome
- aspiration of gastric content > 25 ml
- pH < 2.5
NPO Guidelines
no chewing gun 2 hrs - clears 4 hrs - breast milk 6 hrs - formula, milk meds - 1 hr before up to 150 ml
Diabetes
- hold oral diabetic medication morning of surgery (metformin hold 48 hrs prior)
- take 1/4 - 1/2 of insulin
- check BG on arrival
- total joints - always check BG in OR
Hyperthyroid
sympathetic overactivity
preop goal: euthyroid state
-consider beta-blockers for increased HR (T4-T3)
Adrenal Disorders
-long term steroid use may need stress dosing for procedure
Acoholic
- acute intoxication: lower anesthetic requirements
- withdrawal: increased anesthetic requirements
Cocaine Use
- avoid beta-blockers (decreases coronary flow) (all alpha)
- use calcium channel blockers
Narcotic Use
- increase dose required to induce anesthesia
- will have pain post-op
- ketamine candidate - different receptors
Atypical Pseudocholinesterase
-succinylcholine is unable to be metabolized.
ASA 1
normal, healthy pt
ASA 2
mild systemic disease
slightly limited
ASA 3
- severe systemic disease, not incapacitating
- poorly controlled, chronic disease
ASA 4
- severe systemic disease that is a constant threat
- life threatening
ASA 5
- pt not expected to survive
ASA 6
organ donor
ASA E
emergent case
