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ANE 8510 - Principles of Anesthesia II > Exam 2 - SCIP & ERAS (Grayson's) > Flashcards

Exam 2 - SCIP & ERAS (Grayson's) Flashcards

1
Q

Select the 3 antibiotic performance metrics associated with the SIP (Surgical Infection Prevention) Project:
A. abx d/c within 24 hrs of surgery stop
B. provide prophylactic abx for every patient
C. abx d/c within 12 hrs of surgery stop
D. abx started within 1 hr of incision
E. abx regimen consistent w/ guidelines
F. empiric abx for patient’s with same surgery

A

A. abx d/c within 24 hrs of surgery stop
D. abx started within 1 hr of incision
E. abx regimen consistent w/ guidelines

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2
Q

What was significant about the duration of antibiotic prophylaxis noted with the SIP Project?
A. prophylaxis dose should be started 24 hrs prior to incision
B. excessive use promotes bacterial resistance
C. dose within 1 hour of incision is not indicated
D. there was a negative correlation with SSI incidence

A

B. excessive use promotes bacterial resistance

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3
Q

What is the main goal of SCIP?
A. ensure everyone receives the same treatment
B. decreased length of hospital stay
C. ensure anesthesia and hospital are reimbursed properly for standards of care
D. reduce surgical mortality and morbidity

A

D. reduce surgical mortality and morbidity!!

EDIT since previous exam: B. length of stay could also be correct…

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4
Q

What national organization was notably missing from the SCIP steering committee?

A

AANA

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5
Q

What are antibiotic measures associated with the SCIP? select 3.
A. correct abx choice based on procedure
B. administer prophylactic antibiotic within 30 minutes of incision
C. d/c abx within 48 hrs of cardiac surgery
D. correct abx choice based on provider preference
E. continue abx until patient is d/c home
F. administer prophylactic vancomycin or clindamycin within 2 hrs of incision

A

A. correct abx choice based on procedure
C. d/c abx within 48 hrs of cardiac surgery - but d/c abx within 24 hrs for non-cardiac surgery unless there is documented/suspected infection
F. administer prophylactic vancomycin or clindamycin within 2 hrs of incision - any other abx should be given within 1 hour of incision

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6
Q

What are the two antibiotics that can be given within 2 hours of incision?

A

Vancomycin and clindamycin

note: the HAIs ppt stated vanco and fluoroquinolones..

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7
Q

What are the β-blocker measures associated with SCIP? select 2.
A. beta blocker w/in 24 hrs of surgery start for all pts on chronic bb therapy
B. beta blocker held for 48 hrs after surgery for pts on chronic bb therapy
C. beta blocker w/in 12 hrs of surgery start for all pts on chronic bb therapy
D. beta blocker restarted after surgery for all pts on chronic bb therapy

A

A. beta blocker w/in 24 hrs of surgery start for all pts on chronic bb therapy
D. beta blocker restarted after surgery for all pts on chronic bb therapy

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8
Q

T/F: The CRNA may only remove hair with clippers and document it appropriately.

A

True: Documentation of appropriate hair removal w/ clippers only (no razors/shaving!!).

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9
Q

What is the foley catheter measure associated with SCIP?
A. Every patient must have a foley placed perioperatively
B. Upon removal of Foley, patient must void before leaving the PACU.
C. Remove foley on or before POD 2 unless an order for extension exists
D. Extend use of Foley catheter for every patient that is ICU status

A

C. Remove foley on or before POD 2 unless an order for extension exists - and this reason to extend must also be documented

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10
Q

What is the blood sugar measure associated with SCIP? select 2.
A. non-cardiac pts w/ controlled post-op BG of </= 180 at 6am
B. non-cardiac pts w/ controlled post-op BG of </= 200 at 6am
C. BG should be </= 180 within 18-24 hrs after anesthesia end
D. cardiac pts w/ controlled post-op BG of </= 200 at 6am
E. BG should be </= 150 within 18-24 hrs after anesthesia end

A

C. BG should be </= 180 within 18-24 hrs after anesthesia end
D. cardiac pts w/ controlled post-op BG of </= 200 at 6am

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11
Q

What is a DVT measure associated with SCIP?
A. TED Hose placed during sx for all procedures >/= 1 hr
B. TED hose placed during sx for all procedures >/= 2 hr
C. SCDs placed during sx for all procedures >/= 1 hr
D. SCDs placed during sx for all procedures >/= 2 hr

A

C. SCDs placed during sx for all procedures >/= 1 hr
Also:
- Orders for DVT prophylaxis on post-op admission orders (unless there’s criteria for not giving it)
- RN administration of DVT prophylaxis within 24 hours of surgery end.

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12
Q

What is one of the temperature measures associated with SCIP?
A. first temp in PACU >/= 96.8F within 15 mins of leaving OR
B. first temp in PACU >/= 97.0F within 15 mins of leaving OR
C. first temp in PACU >/= 96.8F within 30 mins of leaving OR
D. active rewarming occurs in PACU

A

A. first temp in PACU >/= 96.8F within 15 mins of leaving OR
And keep pt normothermic or active warming in OR!!

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13
Q

What are the ASA guidelines for preoperative fasting?

A
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14
Q

Before ERAS:

What were typical preop meds back in the day? select 2.
A. midazolam
B. paracoxib
C. tylenol
D. zofran

A

A. midazolam (and/or fentanyl)
B. paracoxib - or other COX-2 Inhibitors (like celebrex)

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15
Q

A 70kg patient was NPO for 8 hours. What is this patients calculated fluid deficit?

A

40ml + 20mL + 50mL = 110mL/hr

110 x 8hrs = 880 mL deficit

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16
Q

Before ERAS:

How much more of fluid deficit was accounted for if a patient has completed a bowel prep?

A

2-3L added to the calculated NPO deficit

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17
Q

How much in evaporative losses should include in our fluid deficit calculation?

A

4-8 mL/kg/hr

18
Q

What drugs can be used for intraoperative pain management? select 3.
A. midazolam
B. ketorolac
C. ketamine
D. dexmedetomidine
E. COX-2 inhibitors
F. zofran

A

B. ketorolac (Toradol) - 15 mg IV Bolus, reduces opioid requirement
C. ketamine - sub disassociative dose per cornelius so 0.25 mg/kg bolus?
D. dexmedetomidine - 20-40 mcg depending on length of case per cornelius

and:
- Opioids - CV stability ?
- Local LA infiltration by surgeon
- Epidural - had high failure rate back in the day

think of ketadex mix…

19
Q

What risks are associated with Ketorolac (Toradol) use if given high doses?

A

Bleeding & kidney injury

20
Q

left from last year’s class

What is the intraoperative dose of ketamine?

A

0.25 - 0.3 mg/kg bolus
or 5 mcg/kg/min infusion

21
Q

What are the 6 risk factors for PONV?

A
  • Female
  • Non-smoker
  • Young
  • Duration of anesthesia
  • Post-operative opioid use
  • Hx of PONV or motion sickness
22
Q

What are the top two “dissatisfiers” that patients don’t want to experience after surgery?
A. vomiting
B. pain
C. nausea
D. residual weakness
E. gagging on ETT

A

A. Vomiting
E. gagging on ETT

23
Q

What are timeframes for the three phases of care?
Preop:
Intraop:
Postop:

A
24
Q

What are the preoperative “Must-Haves” of the ERAS Protocol? select 2.
A. multimodal analgesia
B. formal pre-surgical patient education
C. limited fasting
D. risk assessment
E. formal discharge education

A

B. formal pre-surgical education and counseling
D. risk assessment w/ standardized optimization

25
Q

Formal, patient-centered education should be: select 2.
A. offered to all patients
B. provided only by the OR nurse
C. only for the outpatient clinics
D. not vary from surgeon to surgeon

A

A. offered to all patients
D. should not vary from surgeon to surgeon

26
Q

What are some pre-op risk assessment examples that can help standardize optimization based on lecture? select 3.
A. ensuring blood sugar is </= 200
B. prehab
C. assessing HbA1c if known diabetic or BMI > 35
D. keep every patient NPO at midnight
E. urine drug screening on most patients prior to surgery
F. proceed with surgery even if patient is in delirium

A

A. ensuring blood sugar is </= 200
B. prehab
C. assessing HbA1c if known diabetic or BMI > 35

27
Q

What are intraoperative “Must-Haves” of the ERAS Protocol? select 2.
A. counseling
B. formal discharge education
C. standardized optimization
D. opioid-sparing multimodal analgesia
E. carb-rich drink up to 2 hrs before surgery

A

D. opioid-sparing multimodal analgesia that continues thru discharge
E. carb-rich drink up to 2 hrs before surgery (limited fasting)

28
Q

What are postoperative “Must-Haves” of the ERAS Protocol? select 2.
A. ambulation w/in 12 hrs of surgery stop time
B. formal discharge education
C. ambulation w/in 8 hrs of surgery stop time
D. Mainly opioid analgesia
E. counseling

A

B. formal discharge education that includes incision care and mobility recs

C. ambulation w/in 8 hrs of surgery stop time

and: Continuation of opioid-sparing multimodal analgesia

29
Q

What are suggested intraoperative interventions of the ERAS protocol? select 2.
A. carb rich drink up to 2hrs before sx
B. no foley placement unless sx > 4hrs
C. opiod-sparing analgesia
D. normovolemia

A

B. no foley placement unless sx > 4hrs and foley out in PACU if placed
D. normovolemia
- Minimize blood loss
- normothermic, normoglycemic
- PONV prevention

30
Q

What are the effects of surgical stress and NPO status on metabolism?

A

↓ glucose uptake
↑ insulin resistance
↑ gluconeogenesis
↑ catecholamines
↑ cortisol
↑ Immunosuppression
↑ Interleukins (1 & 6)
↑ Post-operative lean tissue loss

31
Q

What benefits does CHO (carbohydrate) loading prior to surgery provide?

A
  • ↓ insulin resistance
  • ↑ patient comfort
  • No aspiration events reported (in study)
  • No data on muscle retention
32
Q

What are suggested post-operative interventions of the ERAS protocol? select 2.
A. ambulate within 6 hrs of surgery stop time
B. early nutrition and meals out of bed in chair
C. formal discharge education on incision care
D. avoiding opioids after surgery
E. post-discharge call with patient w/in 7 days

A

B. early nutrition and meals out of bed in chair
E. post-discharge call with patient w/in 7 days
and: Post-discharge office visit within 14 days

33
Q

What crystalloid should be avoided if possible in goal directed fluid therapy?

A

NS
greater role for colloids

34
Q

What are the benefits of not doing a bowel prep?

A
  • Earlier return of bowel function
  • Shorter hospital stay
  • No difference in rate of anastomotic leaks or wound infections.
35
Q

What type of analgesia techniques are preferred over PRN opioids?

A
  • PCA
  • Regional LA
  • Neuraxial
36
Q

What 3 drug classes (or drug) reduce opioid requirements by at least 20-30% especially when given an around-the-clock regimen?

A
  • COX-2 Inhibitors
  • NSAIDs
  • Acetaminophen
37
Q

What drug is useful for treating opioid resistant pain?
A. gabapentin
B. dexmedetomidine
C. ketamine
D. clonidine

A

C. ketamine

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

38
Q

What drugs reduce overall anesthetic drug requirements and not just opioids?
A. ketamine
B. corticosteroids
C. a2 agonists
D. acetaminophen

A

C. α-2 agonists (clonidine, dexmedetomidine)

39
Q

What can be done as part of a multimodal approach to PONV prophylaxis for someone with multiple PONV risk factors?
A. do a TIVA with Propofol instead of GA
B. regional instead of GA
C. avoid nitrous
D. give decadron
E. add a scopalamine patch
F. all of the above

A

all of the above and more lol

40
Q

flip card for diagram to review options for an ERAS multimodal pain mgmt approach

A

ANE 8510 - Principles of Anesthesia II (17 decks)

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