467 Med Eval Flashcards
Medical Evaluation of Surgical Patient
True or false: healthy patients of any age who are undergoing elective surgical procedures without co existing medical conditions still require testing.
False. Only when the degree of Surgical stress may result in unusual changes from baseline state
Six identifiable predictive factors in the revised cardiac risk index
High risk sugrery Ischemic heart disease Congestive heart failure Cerebrovascular disease Diabetes Mellitus treated with insulin Serum creatinine more than 2.0 mg/dl
Defined as inability to walk four blocks or climb two flights of stairs at normal pace
Poor exercise tolerance
True or false. Coronary revascularization before non cardiac surgery may be done to reduce perioperative cardiac events
False. Not recommended. No difference in perioperative and long term cardiac outcomes with or without preoperative coronary revascularization
How long should elective non cardiac surgery be done after placement of bare metal intracoronary stent?
30 days
How long should elective non cardiac surgery be done after placement of drug eluting intracoronary stent?
6 months
Coronary revascularization choice is patient must undergo surgery as early as 14 days after PCI
Ballon angioplasty without stent placement
Agents that reduced perioperative stimulation, ischemic and inflammation during perioperative period
Beta adrenergic antagonist
Statins
Antiplatelets
Study that provided the bedrock data supporting the use of beta blockers perioperatively
Dutch echocardiographix cardiac risk evaluation apply stress echocardiography
(DECREASE)
Key points in the DECREASE study
- Continue beta blockade in patients undergoing surgery and who havs been receiving such therapy chronically
- Avoidance of stopping or starting beta blocker on day of surgery
- Initiation of beta blockers far in advance for patient with immediate or high ischemia or three or more RCRI risk factors
True or false. Beta blockers should be stopped on day of surgery
False. According to the DECREASE study, continue or not do not withdraw beta blocker on day of surgery
True or false. Statin therapy should be continued to reduce perioperative cardiac risk.
True. Number of studies support that perioperative prophylactic use of statin reduce cardiac complications in patients with established atherosclerosis
True or false. Unlike beta blocker, ACEI should be discontinued during and after the perioperative period
False. It importabt to maintain continuity of ACEI.
Constitute the time period of greatest risk for the development of stent thrombosis following implantation of an intracoronary stent
4 to 6 weeks following implantation
How long should DAPT be given for patient who underwent intracoronary stenting?
Ischemic heart disease: at least 6 months
Acute coronary syndrome: at least 12 months
After how mnay days/months can DAPT be interrupted in patients undergoing noncardiac surgery and who underwent intracoronary stenting?
Bare metal stent, (BMA): 30 days after
Drug eluting stent (DES): 6 months after
True or false. Alpha agonist can be given for prevention of cardiac events
False. Clonidine was noted to increase rate of nonfstal cardiac arrest and clinically important hypotension
Noncardiac surgeries associated with higher Mortality risk
Emergent major operation esp elderly
Aortic and other noncarotid major vascular surgery
Prolonged surgery associated with large fluid shift/blood loss
Noncardiac surgery associated with intermediate mortality risk
Major thoracic surgery Major abdominal surgery Carotid endarterectomy Head/neck surgery Orthopedic surgery Prostate surgery
Noncardiac surgery associated with lower mortality risk
Eye, skin and superficial surgery
Endoscopic procedures
Predisposing factors for pulmonary complications perioperatively (14)
URTI Age more than 60 years old COPD Cigarette use American Society of Anesthesia Class more than 2 Functional dependence CHD Serum albumin less than 3.5 g/dl OSA Impaired sensorium Abnormal findings on chest examination Alcohol use Weight loss Spirometry abnormality
Spirometry threshold before lung resection (5)
FEV1 less than 2L
Maximal Voluntary Ventilation less than 50% of predicted
PEF less than 100 L or 50% of predicted value
PCO2 more than 45 mmHg
PO2 less than 50 mmHg
How long should cigarettes smoking be stopped before and after surgery at least?
Cessation of smoking for at least 8 weeks before and until at least 10 days after surgery
How should perioperative hyperglycemia be treated?
IV infusion of short acting insulin or SC sliding scale insulin
