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Physical & Health Assessment (Spring '24) - 1 > Exam 1 Pre-Op Evaluation > Flashcards

Exam 1 Pre-Op Evaluation Flashcards

1
Q

Goals of pre-op evaluation include

A
  1. Obtaining pt’s medical hx
  2. Formulate an assessment of pt’s peri-operative risk / mitigate risk
  3. Develop a plan for any clinical optimization
  4. Plan post-op pain management
  5. Lay out expectations for to patient.
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2
Q

What are the benefits of Pre-op Evaluation from the Patient’s standpoint?

A
  1. Reduce Anxiety
  2. Provide Education (Options)
  3. Discuss Meds
  4. Answer Q’s
  5. Reduce Post-op Morbidity
  6. Advocate what CRNAs do
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3
Q

What are the benefits of Pre-op Evaluation from Anesthesia’s standpoint?

A
  1. Learn Medical Conditions.
  2. Devise an anesthetic plan (Intra/Post-op)
  3. Time for consultants
  4. DNR - reverse for perioperative period
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4
Q

What are the benefits of Pre-op Evaluation from the surgeon/hospital’s standpoint?

A
  1. Decrease cost of peri-operative care
  2. Improve efficiency
  3. Decreases cancellation/delays
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5
Q

Surgical procedures performed under anesthesia requires a _________ by the anesthesia provider.

A

Preoperative Evaluation

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6
Q

Correct diagnosis can be made in ____% of cases on the basis of history alone.

A

56%

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7
Q

What are the components of a medical history?

A
  1. Underlying condition requiring surgery
  2. Known medical problems/past medical issues
  3. Allergies
  4. Medications
  5. Previous surgeries/anesthetic history
  6. Anesthetic related complications
  7. Review of systems
  8. Tobacco/ETOH/Illicit drug use
  9. Functional capacity
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8
Q

What are some examples of anesthetic-related complications?

A
  1. Difficult airway
  2. MH
  3. AChesterase deficiency
  4. PONV
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9
Q

What is the formula for BMI in both metric and imperial

A

Metric (BMI = kg / m2)
Imperial (BMI = 703 x lbs / in2)

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10
Q

What BMI is considered underweight

A

BMI < 18.5

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11
Q

What BMI is considered normal

A

BMI 18.5 - 24.9

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12
Q

What BMI is considered overweight

A

BMI 25.0 - 29.9

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13
Q

What BMI is considered obese

A

BMI 30.0 and above

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14
Q

What are the components to emergent physical examination (AMPLE)?

A
  • Allergies
  • Medications
  • Past Medical History
  • Last Meal Eaten
  • Events leading up to need for surgery/ procedure
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15
Q

What are the components of an airway examination?

A
  1. Mallampati classification
  2. Inter-incisors gap
  3. Thyromental distance
  4. Forward movement of mandible
  5. Range of cervical spine motion: flexion and extension
  6. Document loose or chipped teeth, tracheal deviation
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16
Q

Cardiovascular complications account for ____ perioperative mortalities

A

Almost half

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17
Q

What court case in 1957 established what the practice of informed consent was suppose to look like in the practice of modern medicine?

A

Salgo v Trustees of Leland Standford Hospital

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18
Q

What are the three goals of shared decision making?

A
  • 1)Communicating and 2)helping pts conceptualize risk & benefits of possible interventions
  • Elicit pt’s goals, values, and concerns
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19
Q

What are THREE types of DNR orders in the perioperative period, and what do they entail

A
  1. Full attempt at resuscitation
  2. Limited attempt at resuscitation defined with regard to specific procedures
  3. Limited attempt at resuscitation defined with regard to the pt’s goals and values
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20
Q

What is the percent chance of mortality in a high risk procedure?

A

Greater than 5%

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21
Q

What is the percent chance of mortality in an intermediate risk procedure?

A

1%-5%

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22
Q

What is the prediction tool used to estimate risk of cardiac complications after surgery?

A

Revised Cardiac Risk Index

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23
Q

What is the percent chance of mortality in a low risk procedure?

A

Less than 1%

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24
Q

What are examples of a high risk procedure?

A
  • Aortic and major vascular
  • Peripheral vascular
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25
Q

What are examples of an intermediate risk procedure?

A
  • Intraabdominal surgery
  • Intrathoracic surgery
  • Carotid endarterectomy
  • Head/neck surgery
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26
Q

What are the six components worth 1 point of the the Revised Cardiac Risk Index recommended by the American College of Cardiologist (ACC) and American Hospital Association (AHA)?

A
  • High risk surgery
  • Hx of CHF
  • Hx of cerebrovascular disease (CVD)
  • Ischemic heart disease
  • Cr > 2.0 mg/dL
  • DM requiring insulin
    More than 3 high risk of cardiac event
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27
Q

What are examples of a low risk procedure?

A
  • Ambulatory surgery
  • Breast surgery
  • Cataract surgery
  • Endoscopic procedures
  • Skin surgery
  • Urologic surgery
  • Orthopedic surgery
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28
Q

What is the purpose of a functional capacity assessment

A
  • Assessment of cardiopulmonary fitness
  • Estimates pt risk for major post-op morbidity or mortality
  • Determines if further testing is necessary
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29
Q

A Revised Cardiac Index Score of 0 has a _______% risk of cardiac complications after surgery.

A

0.4%

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30
Q

A Revised Cardiac Index Score of 1 has a _______% risk of cardiac complications after surgery.

A

1.0%

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31
Q

A Revised Cardiac Index Score of 2 has a _______% risk of cardiac complications after surgery.

A

2.4%

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32
Q

A Revised Cardiac Index Score of >3 has a _______% risk of cardiac complications after surgery.

A

5.4%

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33
Q

What is functional capacity measured in?

A

METs (metabolic equivalent of task)

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34
Q

What situations would a surgery be considered an emergency?

A

Life or limb would be threatened if surgery did not proceed within 6 hours or less.

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35
Q

What situation will allow the patient to proceed to the surgery without pre-op cardiac assessment?

A

Emergent Surgery

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36
Q

What is a MET?
What is 1 MET = to?
What is the cut off?

A

MET is the rate of energy consumption

1 MET = 3.5 mL/kg/min

Greater than 4 METs

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37
Q

What 4 cardiac conditions will likely result in postponement of surgery?

A
  1. Acute coronary syndrome
  2. Decompensated heart failure
  3. Significant arrhythmia
  4. Severe valvular disease
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38
Q

What situations would a surgery be considered urgent?

A

Life or limb would be threatened if surgery did not proceed within 6 to 24 hours.

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39
Q

What situations would a surgery be considered time-sensitive?

A

Delay in surgery exceeding 1 to 6 weeks would adversely affect patient outcomes. (etc. EGD, colonoscopy)

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40
Q

What are the 6 steps in the preoperative cardiac risk assessment algorithm?

A
  1. Emergency surgery
  2. Active cardiac conditions
  3. Estimate risk of perioperative death or MI
  4. Assess functional capacity
  5. Assess whether further testing will impact care
  6. Proceed to surgery or consider alternative strategies
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41
Q

How many classes of ASA Physical Status are there?

A

6

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42
Q

What are the 4 additional components Meyer Sakland added onto the ASA PS?

A

Qualifiers on the medical side:
- The planned surgical procedure
- The ability and skill of the surgeon in the partciular procedure contemplated
- The attention to postoperative care
- The past experience of the anesthetist in similar circumstances

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43
Q

What type of individual will be classified as ASA 1?

A

A normal healthy patient.

Healthy non-smoker, little to no EtOH use.

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44
Q

What type of individual will be classified as ASA 2 ?

A

A pt with mild systemic disease: Mild disease only, mild lung disease

w/o substantial functional limitations:
current smokers
social drinkers
pregnancy
BMI 30-40
well-controlled DM/HTN

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45
Q

What type of individual will be classified as ASA 3?

A

A pt with severe systemic disease

Substantive functional limitations: one or more moderate to severe disease.

Poorly controlled chronic diseases:
- MI, CVA, TIA, CAD/stents >3 months
- Moderately reduce EF
- Pacemaker
- HTN
- COPD
- ESRD w/ dialysis
- DM; BMI >40
- Severe ETOH
- Premature infants <60 weeks

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46
Q

What type of individual will be classified as ASA 4?

A
  • A patient with severe systemic disease that is a constant threat to their life
  • Acutely severe disease:
    • Recent (<3 months) MI, CVA, TIA, CAD/stents
  • ongoing cardiac ischemia,
  • severe valvular disorder,
  • severe reduced EF,
  • ARDS
  • ESRD w/o dialysis.
  • sepsis; DIC
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47
Q

What type of individual will be classified as ASA 5?

A

A pt not expected to survive w/o operation.

Ruptured AAA, massive trauma, intracranial bleeding with mass effect, ischemic bowel with multi-organ dysfunction.

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48
Q

What type of individual will be classified as ASA 6?

A

A declared brain-dead patient whose organs are being removed for donor purposes.

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49
Q

What influences perioperative outcome in terms of the anesthesia provider?

A
  • Provider characteristics
  • Error in judgement
  • Mishaps
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50
Q

What influences patient outcomes in terms of the entire surgery?

A
  • Anesthesia
  • Patient disease
  • Errors in judgement
  • Location of postoperative care
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51
Q

What should pre-op testing satisfy in order to be considered useful?

A
  • Diagnostic & therapeutic efficacy & effectiveness
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52
Q

When is preop CBC/H&H warranted?

A
  1. Hx of increased bleeding, hematologic disorders, anti-coag therapy, poor nutritional status
  2. ASA-PS 3 or 4 undergoing intermediate-risk procedures
  3. All pts undergoing major procedures
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53
Q

When is preoperative Renal function testing warranted?

A
  1. DM, HTN, cardiac disease, dehydration, renal disease, fluid overload
  2. ASA-PS 3 or 4 undergoing intermediate-risk procedures
  3. ASA-PS 2, 3, or 4 undergoing major procedures
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54
Q

When are preoperative electrolyte labs warranted?

A
  1. Suspected undiagnosed or worsening condition that will affect peri-op management
  2. Any condition/situation that may cause an imbalance (Renal or hepatic disease, malnutrition, malabsorption, ETOH abuse, HF, arrhythmias, medications that may cause an imbalance)
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55
Q

When is preoperative liver function testing warranted?

A
  1. Liver injury and physical exam findings
  2. Liver problems symptoms : Hepatitis, jaundice, cirrhosis, portal HTN, biliary disease, gallbladder disease, bleeding disorders
  3. GI bleed (indirect)
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56
Q

When is preoperative coagulation testing warranted?

A
  1. Known or suspected coagulopathy indentified on pre-op eval
  2. Known bleeding disorder, hepatic disease, and anticoagulant use
  3. ASA-PS 3 or 4; undergoing intermediate, major or complex surgical procedures
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57
Q

When are preoperative serum glucose and HbA1c testing warranted?

A
  • Known DM (or family Hx)
  • Obesity (BMI >50)
  • CV or intracranial disease
  • Steroid history
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58
Q

When is preoperative urinalysis indicated?

A

Suspected UTI and unexplained fever or chills

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59
Q

What cases are contraindicated with active UTI?

A

Orthopedic surgeries (with implants)

60
Q

When is preoperative pregnancy testing warranted?

A
  1. Sexual activity, birth control use, and date or last menstrual period
  2. All women of childbearing potential
61
Q

When is preoperative ECG warranted?

A
  1. Significant structural heart/valvular disease; CV disease: Ischemic heart disease, chest pain, significant arrhythmias, palpitations, HTN, PAD, DM,syncope
  2. ECG routine in ASA-PS 3 or 4 undergoing intermediate risk procedure.
  3. ECG routine in ASA-PS 2, 3, or 4 undergoing major/high-risk procedure.
62
Q

When is a preoperative CXR warranted?

A
  1. Based on abnormalities identified during pre-op evaluation.
  2. Advanced COPD, bullous lung disease, pulmonary edema, pneumonia, mediastinal masses, suspicious physical exam findings (rales, trachea deviation), fx rib.
63
Q

What are four types of anesthesia?

A
  1. General
  2. IV/Monitored Sedation
  3. Regional
  4. Local
64
Q

Short Hand Lab Values

A

Short Hand Lab Values

65
Q

What level of consciousness is general anesthesia?

What are examples of procedures that utilize general anesthesia?

A

Total loss of consciousness and airway control

Examples: Major surgeries (total joints, open-heart, bowel surgeries, etc)

66
Q

What level of consciousness is IV/Monitored sedation?

What are examples?

A

Minimal (drowsy, able to talk) to deep (sleeping, may not remember surgery/procedure)

Example: Minor surgeries or shorter less complex procedures (Biopsies, colonoscopy)

67
Q

What is the number 1 group of drugs that cause anaphylaxis?

A

Neuromuscular Blockers (Rocuronium #1)

(followed by latex, chlorohexidine, antibiotics, then opioids)

68
Q

What is regioinal anesthesia?

What are examples of when this would be used?

A

Pain management method that numbs a large part of the body using a local anesthetic

Example: Childbirth or joint replacement in elderly patients

69
Q

What NMBA is the number 1 cause of anaphylaxis?

A

Rocuronium

70
Q

What is local anesthesia?

What are examples of when this would be used?

A

Pain management method, usually a one-time injection of local anesthetic that numbs a small area of the body

Example: Skin or breast biopsy, bone/joint repair

71
Q

What antihypertensive medications should be DC’d prior to surgery?

A

ACE inhibitors and ARBs DC’d 24 hours before surgery

72
Q

People with Spina Bifida are at high risk for __________ allergies.

A

Latex

73
Q

What are risk factors for latex allergies?

A
  • Hx of multiple surgery
  • Occupation Exposure to Latex (condom factory)
  • Food allergies that cross react (kiwi, mango, passion fruit, banana, avocado, chestnuts).
74
Q

What two antibiotics are the most common cause of anaphylaxis?

A

PCN and cephalosporin

75
Q

What are some considerations to implement when administering vancomycin?

A
  • Give the abx at a slow rate.
  • Pre-medicate with an anti-histamine.
  • Watch for red man syndrome.
76
Q

What are the two classes of local anesthetics?

A

Amides and Esters

77
Q

What class of local anesthetic is lidocaine?

A

Lidocaine is an amide

Local anesthetics with two i’s are usually amides.

78
Q

What preservative in local anesthetic are people allergic to?

A

Para-aminobenzoic acid (PABA)

79
Q

____________ in local anesthetic causes adverse reaction, not an allergy.

A

Epinephrine

80
Q

Most neuromuscular blockers are ___________ compounds.

A

Quaternary ammonium

81
Q

Cross-reactivity possibility with allergy to neostigmine with ___________.

A

Morphine

82
Q

True allergy to opioids are rare, many patients complain about the side effects such as _________ and __________.

A

Nausea and Vomiting

83
Q

During Pre-op what anti-hypertensive meds would be discontinued?

When will theses drugs be stopped?

A

ACE inhibitors and ARBs (cause horrible hypotension)

Stop 24 hours before surgery

84
Q

Drugs to continue taking before surgery include:

A

Antihypertensives
Cardiac Meds
Oral Contraceptives
MAOI
Anti-depressants
Thyroid Medication
Opioids
Seizure Meds
Eye Drops
GERD medications
Asthma meds
Corticosteroids

A COMATOSE GAC

85
Q

A core measure in anesthesia is that patient taking beta-blockers. They need to have taken the medications within _______ hours before surgery.

A

24 hours

86
Q

Oral contraceptives are high risk for ____________. If you were to d/c, stop __________ weeks prior to surgery.

A

High risk for blood clots

Stop 4 weeks prior to surgery

87
Q

What medication used in anesthesia can void the action of oral contraceptives?

A

Sugammadex

88
Q

What group of medication decrease the duration of action of neuromuscular blockers?

A

Anti-convulsant medications.

89
Q

If statins are abruptly stopped, there is an increase in _________ risk.

A

Cardiac

90
Q

What are pre-op considerations for patients taking aspirin?

How long before surgery, would you ask the patient to d/c their aspirin?

A

Figure out why they are taking aspirin and if it warrants as a medication to continue to d/c prior to surgery.

10-14 days before surgery.

91
Q

What is the main concern with patients taking COX-2 inhibitors prior to surgery?

A

Prolong use of COX-2 inhibitors can affect wound or bone healing

92
Q

What two medications do we want to avoid when a patient is on a MAOI?

A

Meperidine - can result in seizures or serotonin syndrome
Vasopressors (Ephedrine) - BP don’t respond as well

93
Q

What are meds to d/c prior to surgery?

A

Sildenafil (depends)
P2Y12 inhibitors (depends/consult cardio)
ASA (depends)
Warfarin
NSAIDs
Non-insulin anti-diabetic meds
Diuretics (except thiazides for BP)
Post-menopausal HRT
Topical medications
SPAWNN DPT

94
Q

How many days out before surgery would you d/c the following P2Y12 inhibitors:

Clopidogrel and Ticagrelor:
Ticlopidine:
Prasugrel:

A

Clopidogrel and Ticagrelor: d/c 5-7 days before surgery
Ticlopidine: d/c 7-10 days before surgery
Prasugrel: d/c 7-10 days before surgery

95
Q

Do not d/c P2Y12 inhibitors in drug eluting stents until ________ months of dual anti-platelet therapy is completed.

A

6 months

96
Q

P2Y12 inhibitors should be continued in patients for _________ surgery with topical or general anesthesia.

A

Cataract

97
Q

Why would you want to d/c diuretics during the day of the surgery?

What is the exception to this?

A

So the patient won’t be volume depleted when they get to the OR.

Thiazide diuretics for blood pressure management

98
Q

When would you want a patient to continue taking their sildenafil?

A

If they are taking it for pulmonary hypertension

99
Q

How far out will NSAIDs be d/c before surgery?

A

48 hours

100
Q

How many days will warfarin need to be stopped prior to surgery?

A

5 days, substitute warfarin for heparin if needed.

101
Q

How far out will post-menopausal hormone replacement therapy need to be d/c prior to surgery?

A

4 weeks

102
Q

Non-insulin anti-diabetic medications are d/c on the day of the surgery. The only exception is what group of anti-diabetic meds?

When are these medications stopped prior to surgery?

A

SGLT2 inhibitors

stop 24 hours prior to surgery.

103
Q

What are anesthesia considerations to take into account with diabetic patients that take insulin?

A

Clearly explain and write down what you want the patient do so there is no confusion about their insulin management on the day of their surgery.

104
Q

When do we d/c short-acting (regular) insulin prior to surgery?

What happens if it is an insulin pump?

A

Day of the surgery

If it is an insulin pump, continue at basal rate.

105
Q

Who has wider swings of blood sugar during surgery? Type 1 or Type 2 DM?

A

Type 1

106
Q

Type 1 DM: Take ____________ of usual dose of morning long-acting insulin on the day of the surgery.

A

one-third

107
Q

Type 2 DM: Take none or up to __________ of long-acting or combination insulin on day of surgery.

A

half

108
Q

Cortisol is produced by the ___________ .

A

adrenal gland

109
Q

______________ suppresses cortisol secretions at HPA axis.

What is given in to increase to increase cortisol level?

A

Exogenous Glucocorticoids

Hydrocortisone

110
Q

What is the pre-op management for no HPA suppression using steroids?

A

Start with short-duration low-dose steroids.

4 to 8 mg Dexamethasone

111
Q

What is the pre-op management for HPA suppression with >20 mg prednisone/day >3 weeks and in pt with Cushingnoid appearance.

A

Give 100 mg hydrocortisone q8 hrs.

112
Q

Appx ______% of pts take multiple herbs/ vitamins

Out of these patients, ________% will take prescription drugs while taking multiple herbs/ vitamins.

A

50% take multiple herbs/ vitamins

25% take prescription drug

113
Q

What are pharmacologic effects of Echinacea?

What Peri-operative concerns?

A

Activation of cell mediated immunity.

Allergic reactions, decrease effectiveness of immunosuppressants, potential for immunosuppression with long-term use.

114
Q

What are pharmacologic effects of Ephedra (ma huang)?

What are Peri-operative concerns?

When to d/c?

A

Increase HR and BP through direct and indirect sympathomimetic effects

D/c 24 hours prior to surgery

-Risk of MI and CVA from tachycardia and HTN
-Ventricular arrhythmias with halothane
-Depletes catecholamines leading to unstable hemodynamics
-Life threatening with MAOIs

115
Q

What are pharmacologic effects of Garlic?

What are Peri-operative concerns?

When to d/c?

A

Inhibit platelet aggregation, increase fibrinolysis

May increase risk of bleeding

7 days

116
Q

What are pharmacologic effects of Ginger?

What are Peri-operative concerns?

A

Antiemetic, anti-platelet aggregation

May increase risk of bleeding.

117
Q

What are pharmacologic effects of Ginkgo Biloba?

What are Peri-operative concerns?

When to d/c?

A

Inhibit platelet activating factor

May increase risk of bleeding

36 hours

118
Q

What are pharmacologic effects of Ginseng?

What are Peri-operative concerns?

When to d/c?

A

Lowers blood glucose, inhibit platelet aggregation

Hypoglycemia, increase risk of bleeding, may decrease anticoagulant effect of warfarin.

-7 days

119
Q

What are pharmacologic effects of Green Tea

What are Peri-operative concerns?

When to d/c?

A

Inhibits platelet aggregation, inhibits TXA2 formation

May increase risk of bleeding, may decrease anticoagulant effect on warfarin

  • 7 days
120
Q

What are pharmacologic effects of Kava?

What are Peri-operative concerns?

When to d/c?

A

Sedation and Anxiolysis

May increase sedative effects or anesthetics

-24 hours

121
Q

What are the pharmacologic effects of Saw Palmetto?

What are Perioperative concerns?

A

Inhibits 5a-reductase and inhibit cyclooxyrgenase

Increase risk of bleeding

122
Q

What are the pharmacologic effects of St. John’s wort?

What are Peri-operative concerns?

When to d/c?

A

Inhibits NT re-uptake

Induction of cytochrome P450 enzymes, affects cyclosporine, warfarin, steroids, protease inhibitors. May also affect BZD, CCB. Decrease Serum digoxin level. Delayed emergence

5 days

123
Q

What are pharmacologic effects of Valerian?

What are Peri-operative concerns?

A

Sedation

May increase sedative effect of anesthetic, BZD like acute w/d, may increase anesthetic requirements with long-term use.

124
Q

List all herbs that have peri-operative concerns for bleeding.

A

Garlic
Ginger
Ginkgo
Ginseng
Green Tea
Saw Palmetto

125
Q

List all herbs that have peri-operative cardiac concerns.

A

Ephedra

126
Q

List all herbs that have peri-operative concerns for sedation?

A

Kava
Valerian

127
Q

A full meal or something with high fat can be consumed how many hours before surgery?

A

8 hours before surgery

128
Q

What kind of meal is milk and infant formula considered?

When should they be NPO?

A

A light meal.

6 hours before surgery.

129
Q

How many hours NPO for breast milk?

A

4 hours

130
Q

How many hours NPO for clear liquids?

A

1-2 hours

131
Q

____________ tube feeds may be continued to the time of nonabdominal surgery.

A

Post pyloric

132
Q

What is Mendelson syndrome?

A

A condition that increases the risk of aspiration.
Aspiration of >25 mL of gastric residual content with a pH < 2.5
Overproduction of gastric fluids

133
Q

List aspiration prophylaxis.

A

-Decrease gastric volume and acidity (NPO)
-Give non-particulate antacids (sodium citrate) to increase gastric pH
-H2 blockers (ranitidine) increase gastric pH
-PPI (omeprazole), decreases gastric secretion
-dopamine-2 antagonist (metoclopramide), reduce gastric volume.

134
Q

PONV scoring system: Name the four components of the Apfel Score.

What Apfel score would be considered a moderate risk?

What Apfel score would be considered a severe risk?

A

Female gender
History of PONV/motion sickness
Nonsmoker
Postoperative opioids

Moderate risk: 1-2; prevention 2-3 entemetics
Severe risk: 3-4, avoid general anesthetics or use total intravenous anesthetic (TIVA)- no opioids & 2-3 antiemetics

135
Q

PONV scoring system: Name the five components of the Kiovuranta Score.

A

Female gender
History of PONV/motion sickness
Nonsmoker
Age (less than 50)
Duration of surgery (less than 1 hr or greater than 4 hrs)

FAHDN

136
Q

PONV premedication
Scopolamine Patches
Class:
Side Effects:
Consideration:

A

Scopolamine Patches
Class: ACh muscarinic antagonist, crosses BBB
Side Effects: Confusion, sedation, dry mouth, blurry vision
Consideration: Avoid use in confused old people, apply 2-4 hours beforehand

137
Q

PONV premedication
Pregabalin
Class:
S/E:
Considerations:

A

Pregabalin
Class: GABA analog
S/E: visual disturbances, risk of respiratory depression
Considerations: administer pre-induction, visual disturbances, and respiratory depression.

138
Q

PONV premedication
Ondansetron
Class:
S/E:
Considerations:

A

Ondansetron
Class: serotonin antagonist
S/E: prolong QTc
Considerations: give before pt is nauseated, before the conclusion of surgery

139
Q

PONV premedication
Promethazine
Class:
S/E:
Considerations:

A

Promethazine
Class: histamine H1 antagonist
S/E: prolong QTc , sedation
Considerations: administer small doses, dilute, really burns

140
Q

PONV premedication
Dexamethasone
Class:
S/E:
Considerations:

A

Dexamethasone
Class: Steroid
S/E: perineal irritation/burning
Considerations: give slowly

141
Q

All patients should receive prophylactic abx within _________ before surgical incision.

A

1 hour

142
Q

Pt who receives ____________ or a ________ for prophylactic abx should have the abx initiated within 2 hours before surgical incision.

A

Vancomycin
Fluoroquinolone

143
Q

Which medication is the most commonly administered abx before surgery?

A

Cefazolin (cephalosporin) - Broad spectrum Beta-lactam antimicrobial agent

-some cross-reactivity to PCN allergies

144
Q

If a patient is allergic to cefazolin what medication can be given instead?

A

Clindamycin

145
Q

What is the most powerful abx used routinely (MRSA)?

A

Vancomycin

146
Q

The ____________ clinic is a visible partnership among the departments of anesthesia, surgery, nursing, and hospital administration to achieve common goals.

A

preoperative evaluation

Physical & Health Assessment (Spring '24) - 1 (27 decks)

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