ERAS (enhanced recovery after surgery) - EXAM 2

Question 1

Fasting Times

Clear liquids

Answer 1

2 hrs

Question 2

Fasting times

breast milk

Answer 2

4hrs

Question 3

Fasting times

infant formula

Answer 3

6 hrs

Question 4

Fasting Times

Non-human milk

Answer 4

6 hrs

Question 5

Fasting times

light meal

Answer 5

6 hrs

Question 6

Fasting Times

Fried foods, fatty foods, meat

Answer 6

8 hrs

Question 7

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

Answer 7

• CV events - heart attacks & strokes

vioxx recalled

Question 8

What is the 4, 2, 1 rule?

Answer 8

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

Question 9

How much are insensible losses?

• min:
• mod:
• severe:

Answer 9

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

Question 10

What is the toradol dose we use now?

Answer 10

15mg 1-2x

Question 11

What is a “go to” IVP dexmedetomidine dose?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

What is considered “pre-op” period?

Answer 13

• decision for surgery to night before surgery

Question 14

What is considered the “intra-op” period?

Answer 14

• morning of surgery
• intra-op
• PACU

Question 15

What is considered the “post-op” period?

Answer 15

• leave PACU
• remainder of time @ hospital
• post-discharge

Question 16

ERAS - must haves

pre-op - 2 things

Answer 16

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

Question 17

ERAS - must haves

Intra-op: 2 things

Answer 17

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

Question 18

ERAS - must haves

post-op - 2 things

Answer 18

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

Question 19

Pre-op phase:

What are some risk assessment examples?

Answer 19

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

Question 20

Pre-op phase:

What are the 2 goals of risk assessment?

Answer 20

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

Question 21

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

Answer 21

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

Question 22

Penn neurosrugery ERAS pain mgmt

Pre-op:

Answer 22

• Gaba
• NSAIDs
• Opioids

Question 23

Penn neurosrugery ERAS pain mgmt

intra-op:

Answer 23

• NSAIDs
• Opioids
• LA - bupivacaine
• dexamethasone

Question 24

Penn neurosurgery ERAS pain mgmt

PACU & postop floor

Answer 24

• NSAIDs
• Opioids
• Acetaminophen
• Dexamethasone
• Muscle relaxers
• IV opioids

Question 25

# Penn neurosurgery ERAS pain mgmt Home

Answer 25

* NSAIDs * Opioids * Tylenol * Muscle relaxers

Question 26

Ketamine pre-incision dose: intra-op infusion:

Answer 26

0.25 mg/kg bolus infusion: 5mcg/kg/min

Question 27

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

Answer 27

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

Question 28

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

Answer 28

1. neuraxial opioids 2. PCA - basal 3. regional techniques

Question 29

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

Answer 29

* thoracic epidural

Question 29

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

Answer 29

TAP block

Question 30

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

Answer 30

* Thoracic epidural * erector spinae block * thoracic paravertebral block * TAP block

Question 31

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

Answer 31

* Epidural * TAP (T10-T12) * QL (T10-L3)

Question 32

Where can TAP blocks be done?

Answer 32

subxiphoid - ilioinguinal pretty much anywhere

Question 33

Sure things to do for ERAS in pre-op:

Answer 33

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

Question 34

4 things to do for ERAS in intra-op:

Answer 34

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