Chapter 7 Flashcards
Who gave the first public demonstration of general anesthesia at Mass Gen?
William T.G. Morton on October 16, 1846
What are the “A”s of anesthesia?
Amnesia Anesthesia Analgesia Akinesia Areflexia Anxiolysis
Amnesia
Inability to form memories
Anesthesia
Lack of sensation
Analgesia
Relief/lack of perception of pain
Akinesia
Lack of movement in response to surgical stimulus
Areflexia
Blunting of autonomic reflexes- attenuation of reflexic hemodynamic responses to surgical stimulus
Anxiolysis
Decrease in procedure-related anxiety
What does the preoperative assessment include?
Detailed hx
PE
Review of pertinent data and studies
What are the advantages of a preoperative assessment?
Allows further studies to be performed, if indicated
Allows interventions to take place so that the pt may be “optimized”
What is the goal of the preoperative assessment?
Summarize the pt’s status to formulate an anesthetic plan
Which active cardiac conditions should be evaluated and treated before noncardiac surgery?
Decompensated heart failure
Severe valvular disease
Significant arrhythmias
Unstable coronary syndromes
What procedures are considered to have elevated cardiac risk?
Aortic and other major vascular Peripheral vascular Anticipated prolonged surgical procedures associated with large fluid shifts and/or blood loss Carotid endarterectomy Head and neck Intraperitoneal and intrathoracic Orthopedic Prostate
What procedures have a low cardiac risk?
Cataract
Plastic surgery
What are five clinical predictors of cardiac risk independent of the surgical procedure?
Ischemic heart dz Hx of heart failure Cerebrovascular dz Diabetes mellitus Renal insufficiency
When is perioperative cardiac morbidity increased?
In those unable to achieve four METs
What is more predictive of perioperative outcomes than spirometry?
Clinical findings and pt exercise capability
In evaluation of the pulmonary system, what diseases should be inquired about?
Reactive airway dz COPD Tobacco use Oxygen requirement Obstructive sleep apnea sx Recent upper respiratory tract infections
Who is at increased risk of pulmonary complications?
FEV1 <70%
When is the highest likelihood of gastric aspiration?
Induction
Emergence
When is aspiration more likely during the maintenance phase of anesthesia?
If the airway is not protected intraoperatively with an ET tube
What must be in place during heavy sedation?
ET tube
What are specific risk factors for aspiration during surgery and anesthesia?
Recent ingestion of food (<8 hrs for heavy meals, <6 h for light solid food, <2 h for clear liquids) Trauma Gi dysfunction Increased intra-abdominal pressure Use of opioids
When does the ACC/AHA recommend continuing beta blockers?
HTN
Angina
Symptomatic arrhythmias