Exam 1: Pre-Op Assessment

Question 1

Goals of preoperative assessment:

Answer 1

Optimize care, satisfaction, comfort

Minimize M&M, delays, cancellations

Determine post-op disposition

Determine if further consult/diagnostics required

Formulate anesthetic plan

Question 2

Optimal situation for pre-op assessment:

Answer 2

Clinic visit 1 wk pre-op

Question 3

CV/pulmonary conditions requiring early pre-op assessment:

Answer 3

Angina, CHF, MI, CAD, uncontrolled HTN

COPD, asthma, airway abnormalities, home O2

Question 4

Other systemic conditions requiring early pre-op assessment:

Answer 4

DM, adrenal, thyroid disease

Liver, renal disease

GERD, obesity

Kyphosis or SC injury

Question 5

Six reasons to perform pre-operative interviews:

Answer 5

1. Obtain PMHx
2. Formulate anesthetic plan
3. Obtain informed consent
4. Patient education
5. Improve efficiency/cost of perioperative care
6. Use operative experience to motivate patient to better health

Question 6

Components of the general impression physical exam:

Answer 6

Height
Weight
Physical features
Mental status
Vital signs

Question 7

Components of the airway exam:

Answer 7

Mallampati classification
Thyromental distance
ROM
Neck circumference
Interincisor distance
Dentition
Craniofacial deformities

Question 8

Components of the cardiac/pulmonary physical exam:

Answer 8

Auscultation of heart (rate, rhythm, murmurs, carotid bruit)
Pulses
Edema

Lungs: inspection, auscultation, percussion, palpation

Question 9

Components of neuro exam:

Answer 9

Motor
Sensory
Muscle reflexes
CNs
Mental status
Speech

This will be heavily influenced by baseline status, surgical procedure, PHMx

Question 10

IBW calculation:

Answer 10

Male: 105lb + 6lb for each inch over 5ft

Female: 100lb + 5lb for each inch over 5ft

Question 11

Goals of pre-op lab testing (4):

Answer 11

Reduce morbidity
Increase quality of care
Decrease cost of care
Return patient to function

Question 12

Litmus test questions for pre-op lab test:

Answer 12

Will the results change my anesthesia?

Will the results improve the patient’s outcome?

Question 13

Define ASA I:

Answer 13

Normal, heathy patient with no systemic disease

Question 14

Define ASA II:

Answer 14

Mild to moderate systemic disease, well controlled, no functional limitation

Question 15

Define ASA III:

Answer 15

Severe systemic disease, functional limitation

Question 16

Define ASA IV:

Answer 16

Severe systemic disease that is a constant threat to life

Question 17

Define ASA V:

Answer 17

Moribund, not expected to survive with or without surgery

Question 18

Define ASA VI:

Answer 18

Brain dead patient undergoing organ donation

Question 19

Clear liquids NPO guidelines:

Answer 19

2 hours

Question 20

Breast milk NPO guidelines:

Answer 20

4 hours

Question 21

Formula/solids/light meal NPO guidelines:

Answer 21

6 hours

Question 22

Heavy, fried meal/fatty food/gum/candy NPO guidelines:

Answer 22

8 hours

Question 23

Patients at higher risk of aspiration:

Answer 23

Age extremes
Ascites
Metabolic disorders
GERD/hiatal hernia/esophageal surgery
Mechanical obstruction
Prematurity
Pregnancy
Neurologic diseases

Question 24

Information the patient requires from anesthesia (7):

Answer 24

Choice of anesthetic technique & consent

Explanation of IV

Use of local anesthetic, medications, fluids

Airway management

Monitors

Post-op expectations

Pain management