General Preop Assessment

Question 1

Each plan of care must be

Answer 1

individualized and specific based on the patient, surgery and available resources

Question 2

***Pre-op Asssessment Goal

Answer 2

• Goal is to reduce pt. risk and morbidity of surgery

Question 3

Predictor of outcome

***ASA 1

Answer 3

Normal, healthy patient

Question 4

**ASA 2 –

Answer 4

Patient with mild systemic disease

Question 5

***ASA 3 –

Answer 5

Patient with severe systemic disease

Question 6

**ASA 4 –

Answer 6

Patient with life-threatening systemic disease

Question 7

*****ASA 5 –

Answer 7

Patient not expected to survive without the operation

Question 8

**ASA 6 –

Answer 8

Brain-dead patient for organ harvest

Question 9

** E –

Answer 9

emergency surgery, ASA 2E

Question 10

Surgical Complications

Answer 10

 Bleeding

 Infection

Question 11

Pt.s response to surgical stress/specific anesthetics

Answer 11

 Any previous difficulty with anesthesia?

 Hx or FmHx Malignant Hyperthermia

Question 12

*****Understanding of current illness & coexisting medical conditions
 Primary goal :

Answer 12

Reduce morbidity & mortality

Question 13

Alcohol consumption

Answer 13

Cytochrome P450

- Incrses. metabolism & reduces effect of medication

Question 14

• **EFFECT ON ANESTHESIA
• **ETOH________
• ***B-blockers_______
• ***Antibiotics________
• ***Benzodiazepines________
• **Diuretics________

Answer 14

Tolerance to anesthesia
bronchospasm
Prolongation of neuromuscular blockade*
Tolerance to anesthesia
Hypovolemia, hypokalemia

Question 15

****Most antibiotics cause__________
____,______,_____,______ (CLAP) primarily inhibit the pre-junctional release of ACh and also depress post-junctional nAChR sensitivity to ACh.
** Tetracyclines exhibit________

Answer 15

neuromuscular blockade in the absence of neuromuscularblocking agents
 aminoglycosides, polymyxins, lincomycin & clindamycin
-postjunctional activity only.

Question 16

• ***AIRWAY EXAM

* ***TTM

Answer 16

• ** Examine Neck ROM (flexion & extension)

* ** Mallampati, thyromental distance, teeth, mouth opening

Question 17

**Neurological exam

Answer 17

*****Mental Status - Ability to answer health hx Qs.

Question 18

**What are the STRONGEST indicators of Pulmonary Complications

Answer 18

 **The SIZE and TYPE type of surgery are the STRONGEST PREDICTORS for PULMONARY COMPLICATIONS
 **Thoracic Sx
 **Upper Abd. Sx.

Question 19

***Electrolyte panel for pts on for

Answer 19

diuretics or ACE-inhibitors

Question 20

** Electrolytes with BUN/creatinine for pts w

Answer 20

/ cardiac, liver, or kidney ds.

Question 21

*** CBC for pts

Answer 21

w/ hematologic disease, or very young or very old

Question 22

**BMP, CBC, & Coagulation studies for

Answer 22

liver ds.

Question 23

*** Blood glucose for

Answer 23

pts w/ diabetes

Question 24

**H&H for

Answer 24

hx of bleeding, anemia, extremes of age, liver ds.

Question 25

**Coags –

Answer 25

liver, kidney ds, anticoag meds, bleeding disorders

Question 26

**Unclear pregnancy history; s/P______still get_____

Answer 26

 S/P tubal ligation should still get HCG

Question 27

*****Pregnancy likely by history

 When in doubt –

Answer 27

Do one! (do a pregnancy test)

Question 28

****COMPONENTS and PREDICTORS of DIFFICULT AIRWAYS

PTSHD

Answer 28

****High Mallampati Classification
 Small mouth opening
***** Prominent Incisors
*****Thyromental distance <6cm (1 fingerbreadth = 2 cm)
**** Decreased neck extension

Question 29

• **Fasting Guidelines
• **clear
• **breast
• *formula
• **lightfood
• **heavy food

Answer 29

• *Clear Fluids 2h
• *Breast Milk 4h
• **Infant Formula 6h
• **Light Food 6h
• *Heavy Food 8h

Question 30

**Cardiac DISEASE

Answer 30

• ***Uncontrolled HTN (diastolic higher than 110 mm Hg)

* ** Valvular Ds (esp. Aortic Stenosis)

Question 31

*****Exercise Tolerance

Answer 31

– one of the most important determinants in periop. CARDIAC RISK and the need for further testing or invasive monitoring

Question 32

Emergent*Unstable coronary syndrome

Answer 32

 Myocardial infarction within 1 month
 Unstable angina = ischemia

Decompensated HF
severe Valve disease

Question 33

*****Vascular Surgery

Answer 33

*****Reported cardiac risk can be >5%

Includes open aortic and other major vascular surgery

Question 34

**Intermediate Risk Surgery
Cardiac risk is?
what type of surgery ?

Answer 34

***** Reported cardiac risk 1-5%
**Includes peritoneal and intrathoracic surgery, head and neck surgery, carotid endarterectomy, and orthopedic
surgery

Question 35

**Low Risk Surgery

Answer 35

Superficial& Endoscopic, breast and most ambulatory surgery non major surgery

Question 36

**Angioplasy without stent Time to wait for elective surgery

Answer 36

2-4 weeks before surgery

Question 37

*****Bare metal stent and CABG Time to wait for elective surgery

Answer 37

at least 6 preferable 12 weeks

Question 38

**Drug eluting stent placement Time to wait for elective surgery

Answer 38

At least 12 months

Question 39

• *** Diabetes mellitus –
• *** ↑ risk of 3 conditions
• *** Autonomic neuropathy =

Answer 39

most common Endo. Ds in sx pts
CAD, Periop. MI and CHF
hemodynamic instability as well as pulm. Aspiration from gastroparesis

Question 40

**Patients highly sensitive to respiratory depressive effects

Answer 40

INHALED ANESTHETICS
SEDATIVES
OPIOIDS

Question 41

*****Which patients are highly sensitive to respiratory depressive effects?

Answer 41

OSA

Question 42

• **% females with OSA

* ***% males with OSA

Answer 42

9%; 24%