4. Perioperative Considerations Flashcards
what is the ASA classification for a normal healthy patient?
ASA class 1
what is the ASA classification for a patient with mild systemic disease?
ASA class 2
what is the ASA classification for a patient with severe systemic disease that limits activity, but is not incapacitating? (e.g. diabetes, HTN)
ASA class 3
what is the ASA classification for a patient with incapacitating systemic disease that is a constant threat to life?
ASA class 4
what is the ASA classification for a moribound patient not expected to sruvive 24 hours with or without surgery?
asa class 5
what is the ASA classification for an emergency surgical procedure?
E
what scan would you order to evaluate tumors and fractures?
CT scan
what scan would you order to look at soft tissue, evaluate for tumors, infection and tendon pathology?
MRI
what happens to blood sugar prior to surgery?
blood glucose levels rise with the stress of surgery
what effect does albumin have on healing?
low albumin inhibits healing
elective surgery should be avoided when blood sugar is greater than what?
200mg/dl
how would you dose a patient on insulin before surgery?
give one half insulin dose preoperatively and second half of insulin after surgery and give 5% dextrose
what are the goals of surgery in the rheumatoid patient?
- pain relief
- improvement of overall fxn
- correction of the deformity
how do you adjust meds for an RA patient on ASA and NSAIDs prior to their surgery?
stop ASA 2 weeks prior to surgery
stop NSAIDs 3-5 days before surgery
how do you supplement cortisol for an RA patient pre-operatively?
hydrocortisone 100mg IV/IM evening prior to surgery
- another dose before surgery and continue every 8 hrs for the next day post-op
- *do not need to supplement if <5.0 mg/day or intra-articular injection
