Anesthesia Flashcards
What are the signs and symptoms of lidocaine toxicity?
- Seizures
- Profound hypotension
- Perioral numbness
What are the 6 classifications of ASA?
(a) ASA I: normal, healthy patient
(b) ASA II: mild systemic disease
(c) ASA III: severe systemic disease
(d) ASA IV: severe systemic disease that is a constant threat to life
(e) ASA V: moribund patient not expected to survive without operation
(f) ASA VI: brain-dead organ donor
What is the RCRI risk factors list?
(i) High-risk procedure
(ii) History of ischemic heart disease
(iii) History of CHF
(iv) History of cerebrovascular disease
(v) Preoperative treatment with insulin
(vi) Preoperative serum creatinine >2 mg/dL
Class I: zero risk factors, 0.4% risk of mortality
Class II: 1 risk factor, 0.9% risk of mortality
Class III: 2 risk factors, , 6.6% risk of mortality
Class IV : 3 or more risk factors, 11% risk of mortality (highly recommend BB)
MELD Score?
Model for End-Stage Liver Disease
- Measures creatinine, INR, and bili (predicts mortality rate)
What is the endogenous cortisol output in an adult?
Normal adult: 8-25mg/day
What is the endogenouse cortisol output for an adult undergoing major surgery?
75-100mg/day
How to prevent adrenal insufficiency?
100mg Hydrcortisone IV
What is the Wells criteria for DVT?
Predict the likelihood of DVT
(i) Lower extremity trauma, surgery, or immobilization (+1)
(ii) Immobilization (3 days) or recent surgery (4 weeks) (+1)
(iii) Tenderness along femoral or popliteal vein lines (+1)
(iv) Limb swelling (+1)
(v) Calf enlargement (>3 cm circumference, 10 cm below tibial tuberosity) (+1)
(vi) Pitting edema (+1)
(vii) Dilated collateral superficial veins (nonvaricose) (+1)
(viii) Previous DVT (+1)
(ix) Malignancy (6 months) (+1)
(x) IV drug use (+3)
(xi) Alternative diagnosis more likely than DVT (–2)
(b) Total score 0–1: unlikely for DVT
(c) Total score 2+: likely for DVT
What is the Wells criteria for PE?
(i) Clinical signs/symptoms of DVT (+3)
(ii) PE is likely diagnosis (+3)
(iii) Tachycardia (heart rate >100 beats/min) (+1.5)
(iv) Immobilization (3 days) or recent surgery (4 weeks) (+1.5)
(v) History of DVT or PE (+1.5)
(vi) Hemoptysis (+1)
(vii) Malignancy (6 months) (+1)
Score 0-4: unlikely for PE
Score 5+: likely for PE
What are the clinical signs for severe malnutrition?
(1) Weight loss >15% over the previous 3 months
(2) Hypoalbuminemia (<3.0 g/dL)
(3) Anergy
(4) Transferrin <200 mg/dL
What is the best skin prep in terms of hair?
Remove hair on the day of surgery with an electric clipper?
When is shaving bad for surgery?
Shaving the night before surgery is associated with compensatory bacterial proliferation and increased risk of wound infection.
6 indications for endocarditis prophylaxis:
(1) Prosthetic heart valves
(2) Congenital valve disease
(3) Rheumatic valve disease
(4) History of endocarditis
(5) Idiopathic hypertrophic subaortic stenosis
(6) Mitral valve prolapse with murmur (Barlow syndrome)
What is the minimum gauge IV catheter need to initiate anesthesia?
18 gauge IV catheter
What do you do with insulin on the day of surgery for patients with diabetes requiring insulin?
Use half the dose of long lasting insulins
