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SRNA4TopicsAnesthesia > Exam 1 Reading 2 (B.Ch23) > Flashcards

Exam 1 Reading 2 (B.Ch23) Flashcards

1
Q

Best way to screen for occult CV disease

A

Inquire about the patient’s ability to exercise at 4 METs.

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2
Q

Exercise considered 4 METS

A

climbing 1-2 flight of stairs

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3
Q

Watching TV how many mets

A

MET 1

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4
Q

Eating dressing

A

MET 2

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5
Q

Walking on ground level 2-3mph, light housework

A

MET 3

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6
Q

METS> 10

A

Playing strenuous sports

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7
Q

CV questions to ask

A

Exercise tolerance
Angina
DOE
HTN

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8
Q

Pulmonary questions to ask

A

Smoking
COPD
Asthma , OSA

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9
Q

GI questions to ask

A

Reflex, obstruction

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10
Q

Endocrine questions to ask

A

Diabetes, thyroid

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11
Q

Vascular questions to ask

A

Peripheral vascular, aneurysm.

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12
Q

Hepatic questions to ask

A

Liver disease, alcohol

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13
Q

Musculo questions to ask

A

RA

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14
Q

Drugs known to have interactions with anesthetics

A

MAOIs

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15
Q

Some medication with knonw rebound effects

A

Propranolol

Clonidine

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16
Q

Patients on chronic beta blocker should they continue? why>?

A

Patient on chronic beta blocker should continue their meds because abrupt withdrawal may lead to angina, ischemia dysrhythmias

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17
Q

Which one may be continued perioperatively CCB or BB

A

CCB

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18
Q

Can you continue ACEI and ARBs, why or why not?

A

You cannot because it they have been know to cause refractory hypotension

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19
Q

When do you D/C diuretics?

A

Night before surgery to avoid intravascular volume depletion

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20
Q

What about statins and peri-operative?

A

Statins reduces the morbidity and mortality risk so should be continue perioperatively especially for patient undergoing vascular surgery. .

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21
Q

What dose of prednisone would the patient be at risk for adrenal suppression?

A

> 5mg ; you have to administer supplemental glucocorticoids

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22
Q

Perioperatively: What about oral hypoglycemic drugs and short acting insulin?

A

Withheld the morning of surgery

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23
Q

Perioperatively: What about Intermediate and long acting insulin?

A

Reduced dose on the day of surgery

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24
Q

Perioperatively: Metformin; should it be discontinued and when?

A

Associated with an increased risk of lactic acidosis in the contxt of severe dehydration. Yes 24 hours prior to surgey

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25
Q

When do yo D/C oral contraceptives and prior to surgery and why ?

A

4-6 weeks , because high risk for Thromboembolism.

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26
Q

For minor surgeries what perioperative supplementation?

A

Take usual morning dose of steroid

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27
Q

For moderate surgeries what perioperative supplementation?

A

Take usual morning dose of steroid
Administer 50 mg hydrocortisone IV prior to induction
25mg IV every 8 hours for 24 hours

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28
Q

For severe surgeries what perioperative supplementation?

A

Take usual morning dose of steroid
Administer 100 mg hydrocortisone IV prior to induction
50mg IV every 8 hours for 24 hours

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29
Q

Why are MAOIs bad?

A

Inhibit breakdown of monoamine neurotransmitters including dopamine, serotonin, epinephrine and NE.

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30
Q

Giving an MAOI, with indirect acting sympathomimetic agents?

A

Hypertensive crisis

Serotonin syndrome

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31
Q

How long do you hold ASA before surgeries?

A

7-10 days ( action of aspiring is to decrease platelet aggregation, therefore, put the patient at risk for increase surgical bleeding.

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32
Q

How long do you hold clopidogrel and ticagrelor should be stopped?

A

5 days

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33
Q

How long do you hold prasugrel should be stopped?

A

7 days

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34
Q

How long do you hold should be stopped?

A

10 days

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35
Q

How long do you stop ibuprofen and naproxen

A

3-5 days

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36
Q

How long do you hold warfarin ?

A

5 ays

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37
Q

LMW heparin last dose should be administered

A

24 hours before the start of the procedure.

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38
Q

Dabigatran shoud be stopped when ? what indicates how long you stop for

A

1-2 days prior to surgery with normal CrCl

and 3-5 day for patients with CrCl < 50

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39
Q

When should diabetic surgery be scheduled for?

A

First case of the day to avoid prolonged fasting

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40
Q

For patient with Type I Diabetes, how should you manage insulin?

A

Give half the usual dose of intermediate to long acting insulin on the morning of surgery.

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41
Q

Patients with type I diabetes with an insulin pump?

A

Continue on basal rate; start dextrose containing insulin infusion upon arrival to surgical suite

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42
Q

WHen should herbal and complementary drugs be discontinued 1 week prior to surgery

A

discontinued 1 week prior to surgery

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43
Q

Effects of garlic

A

Inhibits platelet aggregation

44
Q

Effects of St John’s Wort

A

Inhibits serotonin, NE, dopamine,reuptake

Induces CYP 450 , leading to increased drugs metabolism

45
Q

Effects of Feverfew

A

Inhibits platelet aggregation

46
Q

PCN allergy and cephalosporins

A

2% of patients with a documented penicillin allergy will have an allergic reaction to a cephalosporin.

47
Q

Smoking and perioperative outcomes

A

Smoking is also associated with an increased risk of perioperative respiratory complications, including airway hyperreactivity

48
Q

Malignant hyperthermia is a rare but potentially life-threatening

A

anesthetic-triggered disorder of skeletal muscle metabolism that is often inherited in an autosomal dominant fashion.

49
Q

Patients heterozygous or homozygous for the atypical plasma cholinesterase gene may

A

describe prolonged hospital stays or ventilator dependence after brief surgical procedures.

50
Q

A thyromental distance of_______Indicate possible difficult intubation

A

6 cm is suggestive of possible difficult intubation.

51
Q

Preoperative evaluation of dentition is important to determine the presence of

A

prosthetics that should be removed prior to anesthesia and to identify pre-existing loose, chipped, or fractured teeth that might later be erroneously attributed to airway manipulation.

52
Q

The risk of major adverse cardiac event can be stratified by

A

Revised Cardiac Risk Index (RCRI)

53
Q

RCRI identified six independent predictors of cardiac complications:

A
  1. history of ischemic heart disease;
  2. history of congestive heart failure;
  3. history of cerebrovascular accident;
  4. preoperative insulin-requiring diabetes;
  5. creatinine >2.0 mg/dL; and those presenting for
  6. high-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular surgery).
54
Q

The best available evidence suggests that preoperative noninvasive stress testing should be reserved for patients with

A

cardiac risks factors who demonstrate poor (<4 METS) or unknown functional capacity and are undergoing anything other than low risk surgery (MACE risk ≥1%)

55
Q

Surgery time to wait for bare metal stent

A

postponing elective surgery for a minimum of 4 weeks after placement of a bare-metal stent and

56
Q

Surgery time to wait for drug- eluting stent

A

12 months after placement of a drug-eluting stent

57
Q

ICD WHat may cause interference

A

Electromagnetic interference (EMI) from devices in the operating suite, most commonly monopolar electrocautery,

58
Q

ICD Anesthetic interview includes the

A 
Reason for device implantation
Device type and manufacturer
Date of last interrogation
Current programming, 
whether the patient is pacemaker dependent, and the device’s response to application of a magnet
59
Q

When is a MAGNET recommended?

A

When the site of surgery is within 6 inches (15 cm) of the pacemaker, application of a magnet is recommended when there is a risk of EMI

60
Q

When is a magnet unnecessary?

A

When the site of surgery is more than 6 inches from the pacemaker, application of a magnet is

61
Q

How does Induction affects HTN

A

Induction of anesthesia results in sympathetic stimulation that manifests as a rise in blood pressure of about 20 to 30 mm Hg and heart rate of about 15 to 20 beats per minute.

62
Q

Risk factors for Perioperative Pulmonary complications

A 
Smoking
Older age
COPD
Obesity
OSA
63
Q

Effect of smoking of sputum production, ciliary function, and CV? what does it increase ? when should the patient stop smoking to facilitate procedure?

A

Tobacco and nicotine increase sputum production, reduce ciliary function, stimulate the cardiovascular system, and increase carboxyhemoglobin levels. Although smoking cessation for as little as 2 days decreases carboxyhemoglobin levels and improves mucociliary clearance, most studies suggest it takes at least 8 weeks of smoking cessation to reduce the rate of postoperative pulmonary complications.

64
Q

Symptoms suggestive of OSA include a

A

history of snoring, daytime sleepiness, and headaches.

65
Q

What is the most important factor related to the risk of developing pulmonary complications postoperatively?

A

The site of surgery (thoracic and upper abdominal more likely to suffer pulmonary complications)

66
Q

3 implications of having diabetes with the perioperative process?

A

Autonomic neuropathy may predispose those with diabetes to intraoperative hemodynamic instability.
Gastroparesis makes the risk of pulmonary aspiration relatively more likely.
Poorly controlled diabetic patients are also at greater risk of developing postoperative infections.

67
Q

Therefore, in general, guidelines recommend a perioperative glycemic target

A

between 140 and 180 mg/dL.

68
Q

S/s of Hypothyroidism

A

Bradycardia
Cold intolerance
Hypoventilation
Hyponatremia

69
Q

S/S of Hyperthyroidism

A 
Atrial fibrillation
Tachycardia
Tremor
Weight loss
Heat intolerance
70
Q

Pt with hyperparathyroidism

A

hyperparathyroidism, preoperative determination of serum calcium concentration is prudent.

71
Q

RA and its implications on perioperative period

A

cervical joint instability, which must be taken into consideration during intubation. Patients are often maintained on long-term glucocorticoid therapy and may require supplementation perioperatively.

72
Q

Pt with parkinson’s disease

A

Increase risk for hypotension
Aspiration
Post op pulmonary complications

73
Q

Clinical features suggestive of liver disease include a

A

history of heavy alcohol use, hepatitis, illicit drug use, or sexual promiscuity.

74
Q

Patients who are dialysis dependent should ideally be dialyzed

A

as soon prior to surgery as feasible (usually the day before surgery) to optimize preoperative fluid and electrolyte status.

75
Q

2 meds to be continued parkinson and seizure patients

A

Antiepileptic drugs

Parkinson’s drugs.

76
Q

NOnhuman milk how long to wait

A

6 hours

77
Q

Light meal (toast clear liquids)

A

6 hours

78
Q

Infant formula, how long to wait

A

6 hours

79
Q

Breast Milk how long to wait

A

4 hours

80
Q

Role of antacids in reducing risk of pulmonary aspiration

A

Raise gastric pH

81
Q

Example of nonparticulate antacids

A

Sodium citrate (bicitra)

82
Q

Examples of particulate antacids

A

Maalox

83
Q

Compare nonparticulate with particulate

A

nonparticulate antacids, do not cause pulmonary damage if aspirated

84
Q

Role of H-2 Antagonists in reducing risk of pulmonary aspiration

A

Reduce gastric Volume

Increase gastric pH

85
Q

Role of PPIs in reducing risk of pulmonary aspiration

A

Reduce gastric acid secretion

Reduce gastric colume

86
Q

PPI blocks proton pmp on

A

Parietal cells

87
Q

Role of Prokinetic agents in reducing risk of pulmonary aspiration

A

Increase gastric motility

Increase Gastroesophageal sphincter tone.

88
Q

Benzodiazepines commonly used and why?

A

Midazolam
rapid onset 1-2 mintes
Short half life 1-4 hours

89
Q

Drugs given before end of surgery

A

ondansetron, phenothiazines such as perphenazine, butyrophenones such as droperidol, and antihistamines such as dimenhydrinate. These drugs are best administered just prior to the end of surgery for optimal onset of action.

90
Q

Pre-emptive analgesia involves the

A

Administration of analgesics prior to an expected noxious stimuli.
Ketamine, opioids, Gabapentin and pregabalin may be given .

91
Q

What is the most commonly used antibiotic for prophylaxis against SSIs (surgical site infections).

A

Cefazolin, a first-generation cephalosporin, i

92
Q

Antibiotic infusions should be administered within_____what is an exception?

A

1 hour of incision, with the exception of vancomycin and fluoroquinolones, which may be administered within 2 hours of incision.

93
Q

What is the half life of cefazolin

A

2 hours

94
Q

Which factor, discovered during the preoperative interview, warrants delaying a noncardiac surgery?

A

Hx of medically managed MI within the past 45 days.

95
Q

The major clinical predictors of increase perioperative CV risk that warrant further investigation?

A

Hx of CV disease
DM
CVA.

96
Q

How long should noncardiac surgery be delayed

A

at least 60 days following an MI

97
Q

Risk factors for PONV

A 
Female
NON-SMOKER
Large body habitus
Young age
Prior hx of PONV motion sickness
Procedure longer than one hour
98
Q

How long prior to inducion of anesthesia should an antacid be adminsitered

A

15-30 minutes

99
Q

Lab studies associated with increase risk of pulmonary morbidity?

A

Reduced serum albumin levels

Increase Creatinine level

100
Q

2 conditions with highest risk of silent MI

A

DM

HTN

101
Q

PAtient with OSA typically develop those 3 thingsq

A

Hypercabia
Polycythemia (not anemia)
Pulmonary HTN
Right sided HF

102
Q

Surgical sites with the highest risk for postop pulmonary complications?

A

Thoracic
Open aortic
Upper abdominal

103
Q

Select two risk factors predictive of postoperative nausea and vomiting after inhalation anesthesia.

A

Non-smoker

Female

104
Q

Which is the best method for defining coronary anatomy and evaluating ventricular and valvular function?

A

coronary angiography. assess ventricular and valvular function.

105
Q

2 tests that can assess cardiac ejection fraction at rest and under stress.

A

Echocardiography and radionuclide angiography can evaluate cardiac EF at rest and under stressful conditions.

106
Q

The advantages of echocardiography are that it is less invasive, and it is able to check for

A

wall abnormalities, wall thickness, valvular function, and valve area.

SRNA4TopicsAnesthesia (47 decks)

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