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RS Absite > anesthesia and periop > Flashcards

anesthesia and periop Flashcards

1
Q

what are some components of airway assessment?

A

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

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2
Q

Mechanism of curved laryngoscopy blades?

A

inserted into epiglottic vallecula to lift epiglottis

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3
Q

Mechanism of straight laryngoscopy blades?

A

direct retraction of vallecula

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4
Q

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

A 
ischemic heart disease
CHF
Cerebrovascular disease 
DM1 
renal insufficiency (Cr>2)
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5
Q

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

A

3

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6
Q

contraindications to pre op cardiac stress testing?

A
  1. need for emergent surgery
  2. no active cardiac issues undergoing low risk surgery
  3. no cardiac issues with >4METs
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7
Q

what patient populations is ECG recommended in

A
  1. at least one clinical risk factor undergoing vascular procedure
  2. known CV disease undergoing intermediate risk procedure
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8
Q

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

A

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

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9
Q

are volatile anesthetics vasodilators or vasoconstrictors?

A

vasodilators

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10
Q

cardiac effect of propofol

A

negative inotrope

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11
Q

medications associated with malignant hyperthermia

A

succinylcholine, volatile agents (sevoflurane, desflurane, isoflurane)

Nitrous oxide does not trigger MH

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12
Q

clinical signs of malignant hyperthemia while under general anesthesia?

A

hypercapnia, gap metabolic acidosis, muscle rigidity, hyperthermia

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13
Q

Next best step when malignant hyperthermia is identified?

A

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

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14
Q

anesthesia techniques to prevent post op nausea?

A

total intravenous anesthesia

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15
Q

half life of warfarin?

A

40 hours

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16
Q

half life of apixaban

A

8-12 hours

17
Q

half life of aspirin

A

2.5-4 hours

18
Q

half life of clopidogrel (ADP receptor P2Y12

A

6 hours

19
Q

indication for stress dose steroid administration ?

dose/time

A

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

+procedure with minimal stress

20
Q

how to make diagnosis of HPA axis supression?

A

early morning random cortisol < 5mcg/dL

21
Q

what is etomidate’s effect on the HPA axis?

A

adrenal suppression

22
Q

warfarin reversal agent?

A

FFP+vit K or PCC

PCC is immediate and less volume

23
Q

dabigatran (pradaxa) reversal agent

A

idarucizumab or PCC

24
Q

rivaroxaban and apixaban reversal agent?

A

andexanet alfa or PCC

25
Q

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

A

platelets and DDAVP

these agents irreversibly bind to platelets, however.

26
Q

how long to stop warfarin before surgery?

A

5d

27
Q

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

A

48 hours

28
Q

how long to stop aspirin before surgery?

A

usually can be maintained through most elective procedures

29
Q

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

A

5-10d

30
Q

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

A
  1. Triple agent therapy for 4 weeks.

2. Delay an elective surgical procedure until after that time to prevent stent thrombosis.

31
Q

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

A
  1. Triple agent therapy for 6 months.

2. Delay an elective surgical procedure during that time to prevent stent thrombosis.

32
Q

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

A

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

33
Q

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

A
  1. DVT with inciting stimulus: 12 weeks (~3mos)

2. DVT without inciting stimulus: 6 months

RS Absite (10 decks)

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