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Anesthesia & Coexisting Disease > Exam 1 L1 > Flashcards

Exam 1 L1 Flashcards

1
Q

Most stressful part of anesthesia

A

Induction

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2
Q

2 main factors for surgical specific risk

A
  1. Type of surgery

2. Degree of hemodynamic stress

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3
Q

Other surgical specific risk factors

A
  1. Duration of surgery
  2. Age of patient
  3. Comorbidities
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4
Q

Risk of complications related to time of surgery

A

60% risk of 16+ hours in surgery

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5
Q

High risk surgery

  • % reported risk
  • surgeries
A

5%

  • emergent major surgery (esp old age)
  • aortic/major vascular surgery
  • large fluid shifts/blood loss
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6
Q

Intermediate risk surgery

  • % reported risk
  • surgeries
A

<5%

  • CEA (Carotid endarterectomy)
  • Head/Neck
  • intraperitoneal/intrathoracic sx
  • orthopedic/prostate sx
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7
Q

Low risk surgery

  • % reported risk
  • surgeries
A

<1%
- endoscopic/superficial
Cataract/breast surgery

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8
Q

Non-operative or less invasive tx

A

Defer surgery

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9
Q

Delay surgery

A
  • Optimize patients comorbidities
  • consults
  • specialized testing
  • further work up
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10
Q

Individual hx of anesthesia problems

A
  • PONV
  • PDPH
  • difficult intubation
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11
Q

Food allergies

A
  • correlated with latex hypersensitivity

Banana, avocado, kiwi, chestnut, plum, peach, cherry, papaya, tomato, potato, fig, apricot

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12
Q

Pt under influence - plan for surgery?

A

Delay or cancel elective surgery

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13
Q

Pt - EToh Hx

A

D/c within 4weeks

Decreases risk of arrhythmia, infxn, w/d

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14
Q

Pt hx smoking

A

Minimum d/c 12-48h prior to surgery D/c 8weeks prior: decreases risk of PNA, atelectasis

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15
Q

AEs of smoking

A

CVS & O2 carrying to tissues impaired

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16
Q

Labs needed - day of surgery

A

Renal fxn tests, lytes, starting HCT, platelets
Beta HCG - all women of childbearing age
Coags (hx bleeding/bruising (Rx))

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17
Q

Which patients require X-RAY on day of surgery?

A

Trauma, CHF, COPD

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18
Q

Clinical Predictors of increased periop CVS - Major risk

A
  1. Unstable coronary syndrome
  2. Decompensated HF
  3. Significant arrhythmias
  4. Severe Valvular dx
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19
Q

Unstable coronary syndromes associated with increased periop CVS risk

A

Acute (>7d) or recent MI (<3 months) with evidence of ischemic risk
Unstable severe angina

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20
Q

Significant arrhythmias associated with increased periop CVS risk

A
  • High grade AV block: Mobitz II, 3rd degree block
  • Symptomatic ventricular arrhythmia
  • SVT uncontrolled rate
  • afib RVR
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21
Q

Clinical Predictors of increased periop CVS - intermediate risk

A 
Mild angina pectoris 
Previous MI (>3 months) by hx pathological Q waves
Compensated or prior heart failure
DM (esp insulin dependent)
Rena insuff. (creatinine > 2)
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22
Q

Clinical Predictors of increased periop CVS - Minor risk

A 
Advanced Age
Abnormal EKG (other than sinus)
Low functional capacity (can’t climb flight of stairs)
Hx stroke 
Uncontrolled systemic HTN
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23
Q

Definition of one MET

A

The amount of oxygen consumed while sitting at rest and is equal to 3.5 mL per kg body weight per min

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24
Q

METs above 4

A

Able to climb a flight of stairs, dancing, bicycling

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25
Q

Accounts for 1/2 all periop deaths

A

Cardiovascular disease

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26
Q

Associated with postop MI + mortality

A

Degree of preop HTN

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27
Q

HTN defined as

A

BP > 140/90

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28
Q

Prevalence HTN

A

25% adults

70% adults > 70

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29
Q

METs above 9

A

Able to swim quickly, run, or jog briskly

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30
Q

Delay surgery for severe HTN

A

Delay elective surgery: SBP > 200; DBP >115

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31
Q

Proceed with elective surgery for severe HTN

A

SBP <180; DBP < 110

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32
Q

Conditions under which surgery should be postponed

A 
*if possible
Active cardiac conditions
-unstable coronary syndromes (severe/unstable angina, MI)
-decompensated HF/new onset
-significant arrhythmias 
-severe valvular dx (severe AS/MS)
33
Q

Risk factors that increase periop ischemic events

A
  • ischemic heart disease
  • HF
  • TIA/stroke
  • DM
  • renal insufficiency
34
Q

Stent placement - bare metal

A

Postpone (elective) < 30 days

Urgent - continue dual antiplatelet therapy

35
Q

Stent placement - Drug eluding

A

Postpone (elective) < 1 year
*if proceeding —> consult cardiology

Urgent - continue dual antiplatelet therapy

36
Q

Decompensated heart failure

A

“Suffocating” or “air hungry”

37
Q

NYHA Class III & IV - proceed/delay/cancel elective procedures?

A

Postponing

38
Q

Aortic Stenosis - proceed/delay/cancel elective procedures?

A

Severe/critical: Preclude (do not let it happen) non-cardiac surgery
*unless life saving emergency
Echo recommended

39
Q

Risks associated with aortic stenosis

A

40% increased MI risk

50% increased CV death

40
Q

Symptoms associated with aortic stenosis

A 
Angina
Heart failure
Syncope
Decreased ET
Exertional dyspnea
41
Q

Risks associated with aortic insufficiency

A

Well tolerated in periop

ECG needed

42
Q

S/S aortic insufficiency

A

Widened pulse pressure

43
Q

S/S associated with mitral stenosis

A

H/o rheumatic disease

Dyspnea, fatigue, orthopnea, pulm edema, he opts is, afib, pHTN

44
Q

Risks associated with mitral stenosis

A

N/A

Echo + ECG necessary

45
Q

Risks associated with mitral regurgitation

A

Acute: ischemia + infarction

Chronic: mitral stenosis, MVP, cardiomyopathy
chronic - well tolerated periop

ECG/echo may be necessary

46
Q

Risks assoc. with mitral valve prolapse

A

N/A
Also known as late systolic click murmur
Common in women

47
Q

Present in 70% of adults

A

Tricuspid regurgitation
*often occurs with mitral regurgitation
Asymptomatic/not audible on exam

48
Q

Pts with syncope on exertion/family h/o sudden death - surgical prep?

A

ECG

49
Q

Associated with higher risk of periop adverse events

A

SVT, ventricular arrhythmias

50
Q

High risk clinical indicators to postpone elective surgery

A

Uncontrolled afib/vtach

51
Q

Management of cardiovascular implantable electronic devices

A

Disable/set to asynchronous mode if any chance of interference with surgical procedure

52
Q

Interference likely with cardiac implantable device

A

Electrocautery
Radio frequency ablation
MRI
Radiation therapy

53
Q

Intraoperative management of ICDs

A

All procedures above umbilicus that use electrocautery or radiofrequency ablation
Apply magnet over device
remove magnet after procedure, assess device postop

54
Q

Risk of pulmonary problems

A

Smokers, COPD, obesity, > 70 y/o, thoracic or upper abd surgery, anesthesia > 2h

55
Q

BMI

A

(Weight kg / height cm^2) x 10^4

Example: (52/152^2) x 10,000 = 22

56
Q

High risk OSA

A

3 or more:
Stop (snoring, tired, observed(stop breathing), bP
BANG (BMI >35, age > 50, neck circum > 40, gender:m)

57
Q

Low risk OSA

A

<3
Stop (snoring, tired, observed(stop breathing), bP
BANG (BMI >35, age > 50, neck circum > 40, gender:m)

58
Q

ASA physical status classification

A
  1. Healthy
  2. Mild systemic dx, no fxn limitations
  3. Severe systemic dx + fxn limitations
  4. Severe systemic dx + constant threat to life
  5. Moribound pt not expected to survive w/o operation
  6. Brain dead, organs to be harvested
59
Q

NPO - clear liquids

A

Up to 2 hours before surgery

60
Q

NPO - breast milk

A

Up to 4 hours before surgery

61
Q

NPO - light meal or non-human milk

A

Up to 6h before surgery

62
Q

NPO - heavy meal

A

8 hours or more before surgery

63
Q

Lethal triad

A

Hypothermia, Acidosis, + coagulopathy

*refers to coagulopathy assoc. with massive hemorrhage/injury

64
Q

Sepsis requirement

A

SIRS + identifiable source of infxn

65
Q

Endothelium is permeable to _____ solutions

A

Isotonic + hypotonic

66
Q

Major issue in pts with CARS

A

susceptible to nosocomial infxns

Compensatory anti-inflammatory response syndrome

67
Q

Tx - hemorrhage

A
  1. Limit crystalloid use
  2. Optimal transfusion: MTP 1:1:1 (FFP: PLT: RBC)
  3. TXA 1g over 10 mins, then 1g over 8 hours
68
Q

Hyperdynamic shock

A

Sepsis

Traumatic

69
Q

Common denominator in both sepsis + trauma

A

Systemic inflammation

70
Q

Most heat loss occurs

A

During first 40 minutes of case

*decrease FGF

71
Q

Steroid supplementation should be considered for

A

Anyone receiving steroid supplementation (even topical) over past year

72
Q

Universal donor blood

A

O negative

73
Q

Naturally occurring colloids

A

Albumin + FFP

74
Q

Pt population that should not receive albumin

A

TBI

75
Q

SSI - infection to spaces near operation within

A

30 days of surgery

76
Q

Blood cannot be given with

A

LR (d/t calcium = clotting)

77
Q

Prophylactic antbx should be given

A

Within the 60 minutes prior to surgical incision

78
Q

First rule of transport

A

Patient must be stabilized prior to transport

Anesthesia & Coexisting Disease (23 decks)

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