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Senior - Surgery 1 > 3 - Preop Eval > Flashcards

3 - Preop Eval Flashcards

1
Q

Purpose of the pre-op H and P:

A

Determine overall health and risk factors

Discover / stabilize issues prior to surgery

Promote safety / prevent adverse outcomes

Order and interpret pre-op tests

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2
Q

Standard informed consent form contains:

A

The procedure in both medical and layman’s terms

Site of procedure

Primary surgeon

Relative procedural risks

Blood products

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3
Q

What are RBA’s?

A

Risks, benefits, alternatives

Must be explained to pt prior to surgery

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4
Q

Informed consent form is signed by:

A

Surgery team member
Patient
Witness (not on the surgery team)

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5
Q

When can the informed consent form be waived?

A

In an emergency

Signed by two docs

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6
Q

Pre-op labs include:

A

CBC (WBC’s, H/H, platelets)

CMP (liver enzymes, kidney, electrolytes, glucose, bilirubin, albumin)

PT/INR (true liver function when combined with total bilirubin and albumin)

UA (infection, dehydration, protein, glucose, HCG)

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7
Q

NPO for how many hrs prior to surg?

A

6 to 8 hrs

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8
Q

What is it’s emergent surgery and patient was not NPO?

A

NG tube, suction stomach to prevent aspiration risk

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9
Q

Universal protocol includes:

A

Site and sign operative site

Prevents injury on wrong site

“time out” just prior to first cut

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10
Q

Pt’s normally receive ABX prophylaxis within ___ hrs of surgery:

A

1 hr

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11
Q

Prophylactic ABX normally discontinued how long after surgery?

A

Within 24 hrs of surgery

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12
Q

Selection of surgical ABX prophylaxis is based on:

A

The facility’s antibiogram and expected contamination sites (skin, GI tract, etc)

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13
Q

Prophylactic ABX are more likely to be used in which surgeries?

A

GI tract
Implantation of foreign body
Contaminated wounds
Immunocompromised patients

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14
Q

Features of anesthesia consultation:

A

Assessment of airway (Mallampati classification)

Prior tracheal intubation

Assign ASA category

Previous anesthesia reactions

Underlying metabolic dz

Rx/allergies

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15
Q

The Mallampati classification:

A

Class I through IV

I = healthy
II - slightly obscured
III - almost entirely obscured
IV - entirely obscured

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16
Q

The ASA category I

A

Healthy patient

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17
Q

The ASA category II

A

Mild to moderate systemic disorder that need not be associated with the surgical problem

Ex COPD, controlled DM, age extremes, controlled HTN, moderate obesity

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18
Q

The ASA category III:

A

Severe systemic dz that limits activity but it not incapacitating

Ex. Insulin-dependent DM, morbid obesity, stress-induced angina

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19
Q

The ASA category IV

A

Incapacitating, life-threatening systemic dz

Ex. Cardiac ischemia (active), advanced hepatic, pulmonary, or renal dz, CHF, unstable angina

20
Q

The ASA category V

A

Moribund patient - not expected to survive 24 hrs without an operation

Ex. Major brain trauma with increased ICP, shock secondary to major trauma, massive PE (saddle), ruptured AAA, etc

21
Q

Respiratory system risk factors for surg

A 
> 60 yrs old
Smoker
Obese
Symptomatic respiratory dz
Abnormal exam
Abnormal CXR
22
Q

Ways to mitigate surg-related pulm issues:

A

PRN bronchodilators

Smoking cessation

Post-op spirometer (prevent atelectasis)

Post-op deep breathing

Compression devices and anticoagulation (DVT prevention)

23
Q

CV pre-op eval elements:

A 
Risks:
CHF
Valvular dz
Frequent PVC’s on ECG
Any dysrhythmia 
Pulmonary edema or cardiomegaly on CXR
Exercise capability
24
Q

In general, try to postpone surgery until how many months after an MI?

A

6 months

25
Q

GI complications of surg:

A

Aspiration
Increased ABD pressure
Ileus
Post-op GI bleed (mitigate with antacids, PPI’s)

26
Q

H2RA’s and PPI’s can interact with:

A

CYP450 - look up interactions with lidocaine, warfarin, benzos

27
Q

Pre-op hepatic considerations:

A

Hepatomegaly, cirrhosis
Spider hemangiomata
Jaundice (T. Bili > 3)

Hepatic encephalopathy

  • restraints
  • Haldol preferred over benzos
  • lactulose binds ammonia

Baseline labs (bili, alb, PT/INR, NH3)

28
Q

Child-Pugh-Turcotte Chart

A

Slide 18

Parameters: ascites, bilirubin, albumin, PT, seconds over control, INR, encephalopathy

29
Q

Elevated BUN usually indicated:

A

Dehydration

30
Q

Elevated creatinine is correlated with increased ______ in surgery patients

A

Mortality

31
Q

Renal consideration pre-op:

A

BUN/Creatinine
GFR
UA

32
Q

Initial txt for post-op oliguria:

A

IV fluids, NOT diuretics

Be mindful of third spacing (CHF - pulmonary edema, peripheral edema)(ascites)(abdominal compartment syndrome)

33
Q

Why avoid over-stretching joints during surgery?

A

Can lead to neuropraxia

34
Q

Optimum glucose level pre-surgery:

A

80-110mg/dL

35
Q

Pre-op considerations for DM:

A

Increased A1C’s associated with poor outcomes - get that sugar under control before surgery!

Patients should not be controlling their own glucose in-hospital (all interventions - meds, diet - should be in the orders)

36
Q

Pain can cause the posterior pituitary to secrete _____ leading to decreased urine output

A

ADH

37
Q

Pain can stimulate the adrenals to release:

A

Epi
Norepi
Cortisol

38
Q

Common cause of intravascular volume loss with surg?

A

3rd-spacing

Causes vasoconstriction -> decreased renal blood flood -> renin release -> angiotensin -> aldosterone -> Na and water retention

All of that ^ leads to decreased urine output and dilute serum (low Na) due to water retention

39
Q

Sudden stoppage of steroids can cause:

A

Addisonian crisis (HOTN, hyponatremia, hyperkalemia)

Use “stress dose” steroids” in lieu of stopping abruptly

40
Q

More than 12 percent weight loss with surg can lead to:

A

Delayed wound healing
Anergy (immune response failure)
Decreased pulmonary reserve

41
Q

Albumin < 3g/dL suggests:

A

Chronic malnutrition

42
Q

Prealbumin < 16mg/dL suggests:

A

Acute malnutrition

43
Q

Prior to surgery, correct physiologic abnormalities - examples:

A

Restoring circulatory volume
Correcting coagulopathies
Correcting acid-base imbalances
Repleting electrolytes

44
Q

How will a cirrhotic liver feel?

A

Small and fibrotic , hard

Does not present as hepatomegaly

45
Q

MC cause of post-op oliguria

A

Dehydration

46
Q

Did you hear about the guy whose whole left side was cut off?

A

He’s all right now.

Senior - Surgery 1 (8 decks)

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