Basic Principals

Question 1

Who decides if the patient needs to be admitted to ICU post op and who is more likely to be admitted to ICU?

Answer 1

The surgeon and anesthesiologist
Elderly patient and those with significant comorbidities

Question 2

When should glucocorticoids be avoided pre or post op?

Answer 2

Hyperglycemia, increased infection risk, wound complications
AVOID STRESS DOSING

Question 3

Should beta blockers be resumed post op?

Answer 3

Yes if hemodynamically stable

Question 4

If a patient is on CCB, Diuretics, and ACEi pre op when are they held and restarted?

Answer 4

Hold preop and restart when hemodynamically stable

Question 5

Should anti seizure, bronchodilators, Eye drop, and thyroid medications be given preop?

Answer 5

Yes

Question 6

How should insulin orders be managed for surgery? Goal BG?

Answer 6

Give long acting and sliding scale, hold meal time
Hold metformin
BG <180

Question 7

What is the appropriate use for fentanyl?

Answer 7

Pain management in mechanically ventilated
Analgesia properties, rapid onset, short duration

Question 8

What are opiate pain medication options for post op?

Answer 8

Fentanyl, Morphine, Dilaudid, Oxycodone, MScontin

Question 9

What are non-opiate pain medications that can be prescribed post op?

Answer 9

Ketamine, Robaxin, Torodal, Acetaminophen, and Gabapentin

Question 10

What are medication options and risks/benefits for sedation managment?

Answer 10

Propofol/Benzodiazapines: benzos increase incidence of delirium. Propofol is associated with acidosis and cardiac irritability
Precedex: Analgesia and sedative properties

Question 11

What are risks with opiate use?

Answer 11

Dependence and withdrawal
Lethargy
Depressed respiratory effort
Vomiting
Ileus

Question 12

What is the equivalent dosing and duration for morphine, dilaudid, and fentanyl?

Answer 12

Morphine: 10mg 4-5 hrs
Dilaudid: 1.5mg 4-5hrs
Fentanyl 0.1mg or 100mcg 1-1.5hrs

Question 13

What are the risks of hypothermia and the treatment for mild, moderate, and severe levels

Answer 13

Risks: coagulopathy and hemorrhage
Mild: 32-36 C (89.6-98.6F) apply warm blankets
Moderate: 28-32 C (82.4-89.6F) air warming system
Severe: <28C (<82.4F) warm IVF

Question 14

What IVF are prescribed for post op and how is goal rate determined. How is resuscitation monitored? What IVF do we change to if NPO And fluid resuscitated?

Answer 14

NSS or LR
MAP >65
ECHO
D5 1/2 NSS

Question 15

What are general initial vent settings post op?

Answer 15

RR 12-16
PEEP 5
FiO2 100% then wean to 40%
TV 6mls/kg

Question 16

What are three interventions to prevent ARDS?

Answer 16

Prone positioning
Sedation
Short term neuromuscular blockade

Question 17

What are the determining factors for extubation?

Answer 17

Improved/Resolved hypoxemia, hemodynamic stability, no neuro pathology
Spont breathing trial (for at least 30mins)
Rapid Shallow Breathing Index: TV/RR <105 predicts success

Question 18

What are interventions that can be added for aspiration risk patients

Answer 18

HOB 35-40 degrees
Prokinetic agents
Post pyloric and PEG tube