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Principles of Anesthesia II - Fall 2024 > ERAS (enhanced recovery after surgery) - EXAM 2 > Flashcards

ERAS (enhanced recovery after surgery) - EXAM 2 Flashcards

1
Q

Fasting Times

Clear liquids

A

2 hrs

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2
Q

Fasting times

breast milk

A

4hrs

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3
Q

Fasting times

infant formula

A

6 hrs

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4
Q

Fasting Times

Non-human milk

A

6 hrs

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5
Q

Fasting times

light meal

A

6 hrs

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6
Q

Fasting Times

Fried foods, fatty foods, meat

A

8 hrs

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7
Q

What adverse effects were celebrex/vioxx causing when give pre-op?

A
  • CV events - heart attacks & strokes

vioxx recalled

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8
Q

What is the 4, 2, 1 rule?

A

calculates NPO deficit and maintenance rate
* 1st 10 kg = 4mL/kg/hr
* 2nd 10 kg = 2mL/kg/hr
* remaining kg = 1mL/kg/hr

  • 1st 1/2 in 1st hour
  • 1/4 in 2nd hour
  • 1/4 in 3rd hour
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9
Q

How much are insensible losses?

  • min:
  • mod:
  • severe:
A
  • min: 0-2mL/kg/hr (sinus)
  • mod: 2-4mL/kg/hr
  • severe: 4-8mL/kg/hr
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10
Q

What is the toradol dose we use now?

A

15mg 1-2x

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11
Q

What is a “go to” IVP dexmedetomidine dose?

A

20-40mcg (4 mcg/mL)
* 5mL syringe or 10mL syringe

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12
Q

Why don’t we put an NGT in everyone anymore?

A
  • makes reflux worse b/c you put an opening in the esophageal sphincter
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13
Q

What is considered “pre-op” period?

A
  • decision for surgery to night before surgery
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14
Q

What is considered the “intra-op” period?

A
  • morning of surgery
  • intra-op
  • PACU
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15
Q

What is considered the “post-op” period?

A
  • leave PACU
  • remainder of time @ hospital
  • post-discharge
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16
Q

ERAS - must haves

pre-op - 2 things

A
  1. formal, pre-surgical pt education
  2. risk assessment
17
Q

ERAS - must haves

Intra-op: 2 things

A
  1. limited fasting - carb rich drink up to 2hrs before surgery
  2. opioid sparing, multi-modal analgesia
18
Q

ERAS - must haves

post-op - 2 things

A
  1. ambulation w/i 8 hrs of surgery stop
  2. formal discharge education (incision care, mobility recs)
19
Q

Pre-op phase:

What are some risk assessment examples?

A
  • blood sugar
  • smoking cessation
  • medications, polypharmacy
  • anemia
  • frailty/delirium
  • BMI/obesity
  • OSA
20
Q

Pre-op phase:

What are the 2 goals of risk assessment?

A
  1. optimize the physical, mental, and functional status
  2. reduce the dramatic stress response of surgery
21
Q

What are 7 effects of surgical stress & NPO on metabolism?

A
  1. increased immunosuppression & insulin resistance
  2. decreased glucose uptake
  3. increased gluconeogenesis
  4. increased catecholamine surge
  5. increased cortisol, glucagon, GH
  6. increased IL-1 & IL-6
  7. increased lean tissue loss
22
Q

Penn neurosrugery ERAS pain mgmt

Pre-op:

A
  • Gaba
  • NSAIDs
  • Opioids
23
Q

Penn neurosrugery ERAS pain mgmt

intra-op:

A
  • NSAIDs
  • Opioids
  • LA - bupivacaine
  • dexamethasone
24
Q

Penn neurosurgery ERAS pain mgmt

PACU & postop floor

A
  • NSAIDs
  • Opioids
  • Acetaminophen
  • Dexamethasone
  • Muscle relaxers
  • IV opioids
25
Q

Penn neurosurgery ERAS pain mgmt

Home

A
  • NSAIDs
  • Opioids
  • Tylenol
  • Muscle relaxers
26
Q

Ketamine pre-incision dose:

intra-op infusion:

A

0.25 mg/kg bolus

infusion: 5mcg/kg/min

27
Q

What are the 3 benefits of not using a bowel prep?

A
  1. earlier return of bowel function
  2. shorter hospital stay
  3. no diff. in rates of anastamotic leaks or wound infections
28
Q

According to the ASA task force, what 3 meds are preferred over PRN opioids?

A
  1. neuraxial opioids
  2. PCA - basal
  3. regional techniques
29
Q

What is the cornerstone of pain relief in thoracic & abdominal surgery?

A
  • thoracic epidural
29
Q

What is a block option for pts undergoing C-section instead of putting duramorph in spinals?

A

TAP block

30
Q

What types of regional anesthesia can be used for thoracic surgeries?

A
  • Thoracic epidural
  • erector spinae block
  • thoracic paravertebral block
  • TAP block
31
Q

What types of blocks/regional can be used for abdominal surgeries?

A
  • Epidural
  • TAP (T10-T12)
  • QL (T10-L3)
32
Q

Where can TAP blocks be done?

A

subxiphoid - ilioinguinal
pretty much anywhere

33
Q

Sure things to do for ERAS in pre-op:

A
  1. pre-op counseling
  2. d/c planning
  3. no/selective bowel prep
  4. DVT prophylaxis
  5. pre-warming
  6. Abx prophylaxis
34
Q

4 things to do for ERAS in intra-op:

A
  1. active warming
  2. multi-modal pain mgmt
  3. avoid NGT
  4. multi-modal PONV prophylaxis

Principles of Anesthesia II - Fall 2024 (10 decks)

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