anesthesia and periop Flashcards
what are some components of airway assessment?
Mallampati classification, thyromental distance, underbite, neck range of motion, dentition
Mechanism of curved laryngoscopy blades?
inserted into epiglottic vallecula to lift epiglottis
Mechanism of straight laryngoscopy blades?
direct retraction of vallecula
what are some risk factors for periop cardiac complications in noncardiac surgery?
ischemic heart disease CHF Cerebrovascular disease DM1 renal insufficiency (Cr>2)
for vascular procedure, how many periop risk factors are needed to pursue pre op stress testing?
3
contraindications to pre op cardiac stress testing?
- need for emergent surgery
- no active cardiac issues undergoing low risk surgery
- no cardiac issues with >4METs
what patient populations is ECG recommended in
- at least one clinical risk factor undergoing vascular procedure
- known CV disease undergoing intermediate risk procedure
Fasting guidelines for anesthesia: Clears, breast milk, nonhuman milk, fatty food?
clear liquids - 2 hrs
breast milk - 4 hours
nonhuman milk or formula - 6hrs
fatty food/meat - 8hrs
are volatile anesthetics vasodilators or vasoconstrictors?
vasodilators
cardiac effect of propofol
negative inotrope
medications associated with malignant hyperthermia
succinylcholine, volatile agents (sevoflurane, desflurane, isoflurane)
Nitrous oxide does not trigger MH
clinical signs of malignant hyperthemia while under general anesthesia?
hypercapnia, gap metabolic acidosis, muscle rigidity, hyperthermia
Next best step when malignant hyperthermia is identified?
abort procedure
institute invasive monitoring
cooling should start
prompt administration of dantrolene
anesthesia techniques to prevent post op nausea?
total intravenous anesthesia
half life of warfarin?
40 hours
half life of apixaban
8-12 hours
half life of aspirin
2.5-4 hours
half life of clopidogrel (ADP receptor P2Y12
6 hours
indication for stress dose steroid administration ?
dose/time
long term >3wk
moderate/high dose steroids <5mg/d
+procedure with minimal stress
how to make diagnosis of HPA axis supression?
early morning random cortisol < 5mcg/dL
what is etomidate’s effect on the HPA axis?
adrenal suppression
warfarin reversal agent?
FFP+vit K or PCC
PCC is immediate and less volume
dabigatran (pradaxa) reversal agent
idarucizumab or PCC
rivaroxaban and apixaban reversal agent?
andexanet alfa or PCC
aspirin and P2Y12 inhibitor (clopidogrel, prasugrel, ticagrelor) reversal
platelets and DDAVP
these agents irreversibly bind to platelets, however.
how long to stop warfarin before surgery?
5d
how long to stop non vit K anticoagulants before surgery? (dabigatran, rivaroxaban, apixaban)
48 hours
how long to stop aspirin before surgery?
usually can be maintained through most elective procedures
how long to stop P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) before surgery?
5-10d
how long to wait until surgery after placement of bare metal stent?
- Triple agent therapy for 4 weeks.
2. Delay an elective surgical procedure until after that time to prevent stent thrombosis.
how long to wait until surgery after placement of Drug eluting stents
- Triple agent therapy for 6 months.
2. Delay an elective surgical procedure during that time to prevent stent thrombosis.
in patient with supressed HPA axis, when to restart oral steroids after surgery?
Oral steroids are started when the surgical stress has subsided and the patient can be put back on his or her “home” medications.
in patients with DVT, how long should long term anticoagulation last?
- DVT with inciting stimulus: 12 weeks (~3mos)
2. DVT without inciting stimulus: 6 months
