anesthesia and periop

Question 1

what are some components of airway assessment?

Answer 1

Mallampati classification, thyromental distance, underbite, neck range of motion, dentition

Question 2

Mechanism of curved laryngoscopy blades?

Answer 2

inserted into epiglottic vallecula to lift epiglottis

Question 3

Mechanism of straight laryngoscopy blades?

Answer 3

direct retraction of vallecula

Question 4

what are some risk factors for periop cardiac complications in noncardiac surgery?

Answer 4

ischemic heart disease
CHF
Cerebrovascular disease 
DM1 
renal insufficiency (Cr>2)

Question 5

for vascular procedure, how many periop risk factors are needed to pursue pre op stress testing?

Answer 5

3

Question 6

contraindications to pre op cardiac stress testing?

Answer 6

1. need for emergent surgery
2. no active cardiac issues undergoing low risk surgery
3. no cardiac issues with >4METs

Question 7

what patient populations is ECG recommended in

Answer 7

1. at least one clinical risk factor undergoing vascular procedure
2. known CV disease undergoing intermediate risk procedure

Question 8

Fasting guidelines for anesthesia: Clears, breast milk, nonhuman milk, fatty food?

Answer 8

clear liquids - 2 hrs
breast milk - 4 hours
nonhuman milk or formula - 6hrs
fatty food/meat - 8hrs

Question 9

are volatile anesthetics vasodilators or vasoconstrictors?

Answer 9

vasodilators

Question 10

cardiac effect of propofol

Answer 10

negative inotrope

Question 11

medications associated with malignant hyperthermia

Answer 11

succinylcholine, volatile agents (sevoflurane, desflurane, isoflurane)

Nitrous oxide does not trigger MH

Question 12

clinical signs of malignant hyperthemia while under general anesthesia?

Answer 12

hypercapnia, gap metabolic acidosis, muscle rigidity, hyperthermia

Question 13

Next best step when malignant hyperthermia is identified?

Answer 13

abort procedure
institute invasive monitoring
cooling should start
prompt administration of dantrolene

Question 14

anesthesia techniques to prevent post op nausea?

Answer 14

total intravenous anesthesia

Question 15

half life of warfarin?

Answer 15

40 hours

Question 16

half life of apixaban

Answer 16

8-12 hours

Question 17

half life of aspirin

Answer 17

2.5-4 hours

Question 18

half life of clopidogrel (ADP receptor P2Y12

Answer 18

6 hours

Question 19

indication for stress dose steroid administration ?

dose/time

Answer 19

long term >3wk
moderate/high dose steroids <5mg/d

+procedure with minimal stress

Question 20

how to make diagnosis of HPA axis supression?

Answer 20

early morning random cortisol < 5mcg/dL

Question 21

what is etomidate’s effect on the HPA axis?

Answer 21

adrenal suppression

Question 22

warfarin reversal agent?

Answer 22

FFP+vit K or PCC

PCC is immediate and less volume

Question 23

dabigatran (pradaxa) reversal agent

Answer 23

idarucizumab or PCC

Question 24

rivaroxaban and apixaban reversal agent?

Answer 24

andexanet alfa or PCC

Question 25

aspirin and P2Y12 inhibitor (clopidogrel, prasugrel, ticagrelor) reversal

Answer 25

platelets and DDAVP these agents irreversibly bind to platelets, however.

Question 26

how long to stop warfarin before surgery?

Answer 26

5d

Question 27

how long to stop non vit K anticoagulants before surgery? (dabigatran, rivaroxaban, apixaban)

Answer 27

48 hours

Question 28

how long to stop aspirin before surgery?

Answer 28

usually can be maintained through most elective procedures

Question 29

how long to stop P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) before surgery?

Answer 29

5-10d

Question 30

how long to wait until surgery after placement of bare metal stent?

Answer 30

1. Triple agent therapy for 4 weeks. | 2. Delay an elective surgical procedure until after that time to prevent stent thrombosis.

Question 31

how long to wait until surgery after placement of Drug eluting stents

Answer 31

1. Triple agent therapy for 6 months. | 2. Delay an elective surgical procedure during that time to prevent stent thrombosis.

Question 32

in patient with supressed HPA axis, when to restart oral steroids after surgery?

Answer 32

Oral steroids are started when the surgical stress has subsided and the patient can be put back on his or her "home" medications.

Question 33

in patients with DVT, how long should long term anticoagulation last?

Answer 33

1. DVT with inciting stimulus: 12 weeks (~3mos) | 2. DVT without inciting stimulus: 6 months