31. Preoperative assessment Flashcards
VPB and surgery
Proceed if < 30, cardiologist if >30
Afib and surgery
Cardiologist if HR >100
When ACTH higher in surgery
At the end of anesthesia
Where is cortisol released?
Adrenal cortex
MEN 1
MEN 2
MEN 1. 3P. Pituitary, Parathyroid, Pancreas
MEN 2. Pheochromocytoma, Parathyroid, Thyroid
Pheochromocytoma characteristics
Sweating, Headache, Tachycardia
BMI predictor of difficult ventilation
BMI > 26
ARISCAT values
< 26 risk 1.6%
26-44 risk 13.3%
> 45 Risk 42.1%
When contrast induced nephropathy occurs
Increase of Creat 24-48 hours after
CHA2DS2 VASc
CHF
HT
Age > 75
DM
Stroke
Vascular
Age (64-75)
Female
Severe Aortic Stenosis
MP gradient > 40
Speed > 4
< 1 cm
RCRI index
Values
High risk surgery
IHD
CHF
CVA
DM + Insulin
Creat > 2
RCRI index risk
0 — 0.4%
1 – 1%
2 – 2.4%
3 or more – 5.4%
MET if the patient can climb one floor of stairs
MET 5
Stop dabigatran
48 hours
If GFR low 96h
Not correspondence between disease and murmur in
Aortic insufficiency
Tricuspid regurgitation
1 MET
3.5 ml/kg/min
How much time to wait after drug eliciting stent
6 months
Check up of implantable devices
Pacemaker once a year
IDF once every 6 months
CR every 3 months
duke activity status index importance
exists correlation between gold standard measures of functional capacity in surgical patients
Mini cog test
3 words recall + clock draw
Frailty determinants
Weight loss, exhaustion, physical activity, walk time, hand grip
Blood pressure control before surgery and outcomes
Blood pressure control doesn’t improve outcomes
CCS grading
- Ordinary physical activity
- Slight limitation of physical activity
- Marked limitation
- No physical activity
Postponing surgery after BMS / DES
BMS minimum 30 days for non cardiac surgery
DES minimum 6 months
NYHA classification
- No limitation
- Slight limitation
- Marked limitation
- Inability to physical activity
Elective surgery after decompensated HF
One month
Patients with mitral prolapse and significant valve insufficiency
4%
Drugs than can cause long QT syndrome
antiarrhythmics, haloperidol, methadone, erythromycin, cisapride and metabolic abnormalities
Drugs to avoid in brugada
Propofol, bupivacaine
MELD score variables
Bilirubin, creatinine INR
Diseases related with pheochromocytoma
Von Hippel Lindau, MEN, neurofibromatosis type1
Use of scoline in myotonic dystrophy
Not recommended
Recommendation of breastfeeding after surgery with general anesthesia
24 hours
Dibucaine number
80 norm
20 patients with delay wake up after scoline (4-8h)
60 50% 100% delay