Clinical

Question 1

Factors indicating very high perioperative cardiovascular risk?

Answer 1

MI in past month
Unstable angina
Decompensated HF
Symptomatic or uncontrolled arrhythmia
Severe Aortic/Mitral Stenosis

Question 2

Factors indicating intermediate perioperative cardiovascular risk?

Answer 2

Previous MI (>1 month ago)
Stable angina
Compensated HF
Prev stroke
Diabetes

Question 3

What does 1MET mean?

Answer 3

1 MET is the resting energy expenditure (oxygen consumption) of the body. Is is roughly equivalent to 3.5 ml/kg/min.
Functional capacity can be discussed in terms of factors of 1 MET.

Question 4

What functional capacity confers a higher perioperative cardiovascular risk to a patient?

Answer 4

A patient who cannot sustain more than METs of activity is at a higher perioperative risk

Question 5

What types of operation are highest risk in terms of death/MI?

Answer 5

Major emergency surgery (esp. in elderly)
Aortic and infrainguinal vascular surgery
Prolonged surgery with large fluid shifts

Question 6

At what level of stenosis may a patient start complaining of exertional angina?

Answer 6

Roughly 70% occlusion

Question 7

What effect does LVH have on left ventricular filling?

Answer 7

Filling pressures increase

Atrial contraction contributes up to 40% of filling rather than 20% in absence of LVH

Question 8

Absolute contraindications to neuraxial blockade?

Answer 8

Patient refusal
Overlying infection
Hypovolaemia

Question 9

Relative contraindications to neuraxial blockade?

Answer 9

SNAPS:

Sepsis
Neurological impairment
Anticoagulation
Previous spinal surgery
Stenosis of mitral/aortic valves