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NUAN603-Overview of Anesthesia > Lecture 6- Preoperative Assessment > Flashcards

Lecture 6- Preoperative Assessment Flashcards

1
Q

6 Elements of the Preoperative Assessment

A

Introduction:
* Introduce yourself -never lead with student! WE ARE LICENSED PROFESSIONALS
* Verify patient identity (RED RULES- you have to just fricken do it and tell them your role)
* Use lay language and address the patient formally- be respectful
* Discuss wake-up time and know your surroundings- Figure out what your facility does with personal belongings

Interview:
* Systematic review of medical history, Verification of recorded data, Clarify items from the medical record

Exam:
* Conduct a focused physical examination-
* Group physical assessments for efficiency

Consent:
* Obtain informed consent for anesthesia – make sure they have surgical consent too
* Discuss risks to obtain informed consent
o All anesthesia carries the risk of injury (sore throat, teeth, etc) and death

Vital Signs/Monitors:
* Record vital signs and set up monitors (leads, pulse ox, BP cuff)- remember you may need 2 of everything

Plan/Expectations:
* Develop an anesthesia plan of care
* Communicate key patient concerns with other healthcare providers

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2
Q

AANA Scope of practices has 5 parts what are they??

A
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3
Q

3 AANA Standards for pre-operative assessment

A
  • Standard I: Perform a thorough pre-anesthesia assessment
  • Standard II: Obtain informed consent in a language the patient or legal guardian understands
  • Standard III: Formulate patient-specific plan of care based upon comprehensive patient assessment
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4
Q

ASA Preoperative Assessment Standards

I hope we don’t actually need this cause there’s a fuck ton

and most are common sense

A
  • Review medical record
  • Interview and conduct focused pt exam
  • Review medical history
  • Prior anesthetics and medications
  • Obtain/review pertinent tests and consultations
  • Paradigm is changing
  • Determine preoperative medications
  • Anxiolytic or possible opioid
  • Antibiotics ordered by surgeon
  • Check institutional policy for timing of administration
  • Obtain anesthesia consent
  • Document that pre-op assessment was completed in the chart
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5
Q

name a few preoperative assessment settings

A
  • Inpatient – ~ 30-40% of our patients present this way.
  • Anesthesia Preoperative Evaluation Clinics
  • Hospitalist/NP evaluation
  • Same Day Admission
  • Nurse-based assessments
  • Outpatient (the other 60-70% of patients)
  • Surgical Center
  • Physician Office
  • Pre-op telephone assessments- a must
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6
Q

What does an Urgent Vs. Emergent procedure mean?

A

 Hierarchy of case schedules
* Risk of vision, limb, fertility, organ MUST BE PRIORITIZED

  • The in betweens are what makes it hard
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7
Q

Medical Co-morbitities that warrant an early pre- anesthesia assessment:

General

A

o Poor ability to perform ADLs- lots of times done by pre-op will refer to early pre-anesthesia assessment

o Recent hospitalizations

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8
Q

Medical Co-morbitities that warrant an early pre- anesthesia assessment:

CV

A

o History of angina
o Poorly controlled HTN
o CHF
o Recent MI
o Symptomatic arrhythmia- dat new a-fib tho CANCEL

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9
Q

Medical Co-morbitities that warrant an early pre- anesthesia assessment:

Respiratory

A

o Asthma
o COPD
o Abnormal airway anatomy
o Major airway surgery
o Recent URI during flu seasons

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10
Q

Medical Co-morbitities that warrant an early pre- anesthesia assessment:

Hepatic and Endocrine

A
  • Hepatic
    o Active disease (ascites)
  • Endocrine Disorders
    o Diabetes- AIC trends
    o Adrenal
    o Thyroid
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11
Q

Medical Co-morbitities that warrant an early pre- anesthesia assessment:

musculoskeletal

A
  • Musculoskeletal- anything that will mechanically restrict the lungs
    o Kyphosis
    o Scoliosis- lungs is in a cage
    o Severe TMJ
    o Cervical or Thoracic Spine Injury = early assessment
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12
Q

Medical Co-morbitities that warrant an early pre- anesthesia assessment:

GI and ONC

A
  • Oncologic
    o Current chemotherapy- neutropenic
  • GI
    o Morbid obesity
    o Hiatal hernia
    o symptomatic GERD
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13
Q

name the 3 phases and explain the 3 phases of the preoperative eval

A
  1. Review of the Medical Record
    a. Ideally performed prior to the patient interview.
    b. Provides a basis and direction for the patient interview and physical assessment.
  2. Patient Interview
    a. Gain trust and clarify items from the medical record.
  3. Physical Exam
    a. Conduct a thorough physical examination.
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14
Q

Pre-Operative History Summary

these flashcards are killing my soul

A
  • Identify self/patient
  • Identify the planned surgical, therapeutic, or diagnostic procedure (OR schedule may not accurately reflect planned procedure)
    o They have to tell you what they are getting done and who is doing it
    o Pre-op may book it differently based on what tools the surgeon will want in the room
    o Must be specifically listed and that it matches the CONSENT
  • Assess patient understanding of planned procedure
  • Systematic review of medical problems
    o Current medical problems
    o Past medical problems
  • Past surgical and anesthesia history
    o Will show blade, Mallampati, etc A GEM
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15
Q

Tell me about what the Joint CO did in 2004

A
  • Implemented July 2004 to prevent wrong site//procedure/ person surgery – its always the knees
  • Time out prior to the start of the procedure (spinal,block,epidural)/ surgery: 2 step process
  • Document time on anesthesia record, Timing of antibiotics (w/in 1 hr of cut)- 30 min ideal, Fire Risk Assessment (02 promotes combustion, prep is alcohol, cautery- surgeon)
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16
Q

what will the current med history tell you about your anesthetic plan?

A
  • Prescriptions – what they take, doses, time of last dose, reason for each- what they should’ve taken and SHOULD NOT
  • Anticoagulants, Antidepressants (MAOI- serotonin syndrome),

Benzodiazepines (may need more if present),
Cardiac meds,
Narcotics (options with GA AND SPINAL),
Oral hypoglycemic agents and insulin,
Pulmonary, Nonprescription- OTC and Herbals

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17
Q

Whats the worst med a patient could take before surgery and how would you treat it if they did?

A

ACE/ARBS cause PROFOUND hypotension that will not be treatable with the usuals

give VASO

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18
Q

what meds should you take even if fasting before surgery?

A
  • Antihypertensive medications
    o Possible exception: procedures with major fluid shifts, or for patients who have medical conditions in which hypotension is particularly dangerous, discontinue ACEIs or ARBs before surgery.
  • Cardiac medications- MINUS ACE/ARB
  • Antidepressants, anxiolytics, and other psychiatric medications
  • Thyroid medications
  • Birth control pills
  • Eye drops
  • Heartburn or reflux medications
  • Narcotic medications
  • Anticonvulsant medications
  • Asthma medications
  • Steroids (oral and inhaled)
  • Statins
  • Aspirin
    insulins- d/c SHORT acting, DM1 should take 1/3 of their usual long acting
    insulin pump peeps should continue their basal dose
    Monoamine oxidase inhibitors Continue these medications and adjust the anesthesia plan accordingly.
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19
Q

Should patients take aspirin before surgery?

A

o Continue where the risks of cardiac events is felt to exceed the risk of major bleeding (high-grade CAD or CVD)
o If reversal of platelet inhibition is necessary, aspirin must be stopped at least 3 days before surgery.
o In general, aspirin should be continued in any patient with a coronary stent, regardless of the time since stent implantation.

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20
Q

What meds should patients not take on Day of Surgery?

A

Topical medications Discontinue on the day of surgery.
* Oral hypoglycemic agents Discontinue on the day of surgery.
* Diuretics Discontinue on the day of surgery - (exception: thiazide diuretics taken for hypertension, which should be continued on the day of surgery).
* Sildenafil (Viagra) Discontinue 24 hours before surgery.
* COX-2 inhibitors Continue on the day of surgery unless the surgeon is concerned about bone healing.
* Nonsteroidal anti-inflammatory drugs Discontinue 48 hours before the day of surgery.
* Warfarin (Coumadin) Discontinue 4 days before surgery, except for patients having cataract surgery without a bulbar block.
*

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21
Q

What anticoagulant should be d/c’d 4 days prior to surgery

A

COUMADIN

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22
Q

Who has the worst outcomes after surgery?

A

Us

jk

alcoholics

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23
Q

Smoker: Tom, a 45-year-old man.

Smoking History: Tom started smoking at 18 and smoked a pack per day until he quit at age 38.

whats his pack years?

A

1pack/day×20years=1pack/day×20years=20packyears

Pack years: 20 pack years.

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24
Q

Smoker: Sarah, a 50-year-old woman.

Smoking History: Sarah started smoking at 15 and has smoked two packs per day (40 cigarettes) continuously since she was 18.

whats her pack years

A

2packs/day×32years=2packs/day×32years=64packyears

Pack years: 64 pack years.

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25
Q

how long should a pt have stopped smoking to see vascular benefits and decreased risk of complications

A

at least 8 weeks

IE not the night before peoples

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26
Q

what considerations would you think about if a patient likes the cocaine

A
  • Cocaine in all forms- interferes w/ reuptake of norepi

o Know when and how much
o Exaggerated effects of pathways

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27
Q

which recreational drug increases the risk of intraoperative MI

A

Marijuana

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28
Q

what are the current BP guidelines

A
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29
Q

CNS/PNS pt interview- what should you know if they say YES

A

CENTRAL NERVOUS SYSTEM
* Seizure, Tremors, TIA, Stroke, Migraine Headaches, Neuromuscular Disease, Depression, Anxiety Disorder, S/S ↑ ICP &/Or Cerebral Ischemia, H/A, N/V, Pupillary Changes, HTN & Bradycardia, EKG Changes, GCS < 8 Intubation Required

PERIPHERAL NERVOUS SYSTEM
* Assess for Peripheral Neuropathy: Numbness, Tingling, Radicular Pain, Weakness-
o So you don’t get blamed for it
* Properly position to avoid aggravation of symptoms WHILE AWAKE to comfort
* Document presence pre-operatively so change in symptoms is not attributed to intra-op positioning

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30
Q

Patient Interview:

“Hey I’ve had a heart attack or sometimes i get chest pains”

What are you thinking?

A
  • Angina: Stable versus unstable.
    o Unstable angina = ↑ risk of peri-op MI.
    o Incidence, precipitating factors, duration, control with medication WHAT MAKES IT HAPPEN
    o Get yourself a pre-op EKG and monitor INTRA-OP
  • Previous MI- time dependent
    o > 6 months 6% re-infarction
    o 3-6 months 15% re-infarction
    o < 3 months 30% re-infarction but mortality rate 50%
    o < 30 days: highest at-risk period
    o ACC/AHA: wait 4-6 weeks after MI for elective procedure
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31
Q

where should you keep a patient’s BP during Surgery

will def be a thing for the hypertensives of the world

A
  • Evidence of end-organ damage
  • **use anesthetics to treat HTN during a case (remember +/- 20% of normal during surgery to preserve the brain)
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32
Q

What happens if a pt says they have abnormal heart beats in your interview?

A
  • Presence and nature of any arrhythmia
    o Atrial arrhythmia- cancel- need TEE to see if they have clot
    o Controlled versus uncontrolled (rate <100)

o New onset: elective surgery postponed
* Ventricular arrhythmia- find source and reason (electrolytes??)
o Benign
o Malignant

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33
Q

Pt interview “I have a PPM”

now what

A
  • Pacer or AICD
    o Determine if patient is pacer dependent
    o Age and type of pacer

o Use of Bovie
 BOVIE is seen as native electrical activity
* Device may see BOVIE as native rhythm and STOP pacing = bad

  • Magnets: Convert to Asynchronous Mode- magnet master app
    o So many different options
    o Current recommendations from CV sources refer the patient be evaluated by rep to get recommendations
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34
Q

which valvular heart disease would cause severe vasoplegia

won’t tolerate induction or spinal

A

o Severe AS: 14 fold ↑ of sudden peri-op death
o Need constant forward flow- cannot tolerate big changes in BP

 Cannot tolerate spinal either- vasoplegic shock
o Cardiac surgical evaluation prior to elective procedure

o Maintain NSR, SVR, BP and CO
o Avoid hypotension and bradycardia

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35
Q

clinical parameters for pts undergoing non cardiac surgery

Revised Cardiac Risk Index

A
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36
Q

what are the risk classifications to determine cardiac complication rate?

A

o Class I: no risk factors- 0.4%
o Class II: 1 risk factor 0.9%
o Class III: 2> risk factors 6.6%
o Class IV: 3> risk factors 11.1%

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37
Q

Should peeps get BB routinely for surgery?

A

honestly IDK she gave 2 examples

If they were on them already definitely continue

decision to start BB should be individualized weighing risk/benefit

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38
Q

PCI and Surgery Pathway and Surgery

Balloon angio

Bare ass metal

DES

A
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39
Q

AHA preoperative antibiotic coverage for ENDOCARDITIS***

A

o Adult Ampicillin 2gms IV/IM
o Children Ampicillin 50mg/kg IV/IM

o Penicillin Allergy
 Adult Clindamycin 600 mg IV
 Children Clindamycin 20 mg/kg

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40
Q
A
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41
Q

What are examples of diseases included in the respiratory system category?

A

COPD, emphysema, asthma

These conditions can be acute or chronic and are significant for respiratory health.

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42
Q

What is the most important risk factor for post-operative pulmonary complications?

A

Surgical site

Proximity to the diaphragm is also a critical factor influencing lung function.

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43
Q

What factors contribute to increased morbidity and mortality in surgery?

A

Several risk factors including surgical site

Compromised lung function can lead to post-operative pneumonia.

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44
Q

What should be assessed in a patient with asthma before surgery?

A

Frequency of attacks, time since last attack, severity of attacks

Other factors include triggers, recent URI, degree of control, and use of inhalers or oral steroids.

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45
Q

List common triggers for asthma attacks.

A
  • Allergens
  • Upper respiratory infections (URIs)
  • Stress
  • Cold air
  • Exercise

Identifying triggers can help manage asthma preoperatively.

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46
Q

What is the recommendation for COPD patients before going to the OR?

A

Give them supplemental oxygen

This is important for managing their respiratory status.

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47
Q

What symptoms characterize COPD?

A
  • Dyspnea
  • Coughing
  • Wheezing
  • Sputum production

Advanced disease may present with a barrel chest and pursed-lip breathing.

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48
Q

How does a recent upper respiratory tract infection impact pediatric patients?

A

Increases the risk of peri-operative complications 2-7 times

This is particularly true for patients under 1 year of age.

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49
Q

What should be avoided in adult patients with recent URI?

A

General anesthesia if possible

Laryngeal mask airway (LMA) is preferred over endotracheal tube (ETT) to reduce airway irritation.

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50
Q

What does the STOP-BANG questionnaire assess?

A

Risk factors for obstructive sleep apnea

It includes factors like history of cigarette use and ASA-PS scores.

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51
Q

What are some additive risk factors for postoperative pulmonary complications?

A
  • History of cigarette use
  • ASA-PS scores of 2 or more
  • Age 70 years or more
  • COPD
  • Neck, thoracic, upper abdominal, aortic, or neurologic surgical procedures
  • Anticipated prolonged procedures (≥2 hours)
  • Planned general anesthesia
  • Albumin concentration less than 35 g/dL
  • Inability to walk two blocks or climb one flight of stairs
  • BMI of 30 or more

The presence of multiple factors increases the chance of complications.

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52
Q

What gastrointestinal issues can affect surgical outcomes?

A
  • Abdominal distention
  • Obstruction
  • Delayed gastric emptying
  • Dysphagia
  • Peptic ulcer disease and/or history of GI bleeding
  • Hiatal hernia
  • GERD

Severity of GERD may require daily treatment or pre-treatment before surgery.

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53
Q

What is a key strategy for managing Post-operative Nausea and Vomiting (PONV)?

A

TIVA (Total Intravenous Anesthesia)

Includes the use of a Propofol drip and avoidance of volatile anesthetics.

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54
Q

What is the recommended dosage for Propofol drip when receiving general anesthesia?

A

25 mcg/min- she just said this IDK if its official

This is advised if the patient is receiving general anesthesia.

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55
Q

List two medications used in multimodal treatment of pain for PONV.

A
  • Scopolamine patch
  • Decadron
  • 5 HT3 blocker: Ondansetron
  • H2 blocker: Famotidine
  • H1 blocker: Benadryl
  • NK1 blocker: Emend

These medications help manage pain and prevent PONV.

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56
Q

What are the two types of hepatobiliary disease mentioned?

A
  • Acute disease
  • Chronic disease

Includes conditions like Hepatitis and Cirrhosis.

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57
Q

What is a significant complication associated with renal system issues during surgery?

A

Renal Insufficiency

This can complicate drug metabolism and excretion.

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58
Q

What impact does dialysis have on potassium and volume?

A
  • Good for potassium
  • Bad for volume/anemia

Dialysis can help remove excess potassium but may worsen volume status or anemia.

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59
Q

What endocrine disorders require a medication management plan?

A
  • Thyroid Disease
  • Hyperthyroidism
  • Hypothyroidism
  • Adrenocortical Disorders

These conditions may need adjustments in medication before surgery.

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60
Q

What is a consideration for diabetic patients regarding surgery timing?

A

Morning case vs afternoon case

Afternoon surgeries can lead to hypoglycemia.

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61
Q

What type of insulin should be continued preoperatively?

A

Basal insulin (1/3-1/2 dose)

Prandial insulin is typically held.

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62
Q

What should be avoided in diabetic patients during the perioperative period?

A
  • Ketoacidosis
  • Hypoglycemia

These conditions pose serious risks during surgery.

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63
Q

What factors are associated with renal system issues?

A
  • Hypertension
  • Cardiovascular Disease (CVD)
  • Increased intravascular volume
  • Electrolyte disturbances
  • Metabolic acidosis

These factors can complicate surgical outcomes.

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64
Q

What assessment is important for patients with liver disease?

A

Algorithm to Assess Degree of Liver Disease

This helps stratify risk for surgery.

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65
Q

What is a key factor to monitor in patients with diabetes during the perioperative period?

A

Frequency of intra-operative blood sugar checks

This is crucial for managing blood glucose levels.

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66
Q

What is obesity defined as?

A

> 20% above Ideal Body Weight (IBW)

Obesity is determined based on the individual’s Ideal Body Weight, which is a standard measure to assess healthy body weight.

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67
Q

What is the formula for calculating Body Mass Index (BMI)?

A

BMI = kg/height in m²

This formula requires weight in kilograms and height in meters squared to determine BMI.

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68
Q

How do you convert inches to centimeters?

A

1 inch = 2.54 CM

This conversion is essential for calculations involving height when determining IBW or BMI.

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69
Q

What is the Ideal Body Weight (IBW) formula for women?

A

W: 105 + 5 lbs for each inch over 5ft

This formula provides a guideline for estimating a woman’s ideal body weight based on her height.

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70
Q

What is the Ideal Body Weight (IBW) formula for men?

A

M: 110 + 5 lbs for each inch over 5ft

This formula provides a guideline for estimating a man’s ideal body weight based on his height.

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71
Q

How is rough IBW estimated using height in centimeters?

A

Drop the 1 at the front of height in cm

For example, a patient who is 5’3” (160 cm) would have a rough IBW of 60 kg.

72
Q

What does a BMI of 24 kg/m² indicate?

A

Normal weight range

A BMI of 24 kg/m² is typically considered within the normal weight range.

73
Q

What does a BMI of 43 kg/m² indicate?

A

Obesity

A BMI of 43 kg/m² is classified as obesity, indicating significant excess body weight.

74
Q

What are common symptoms of hematologic disorders?

A
  • Bleeding tendency
  • Easy bruising

These symptoms may indicate underlying blood disorders that require further investigation.

75
Q

What therapies are associated with increased bleeding tendency?

A

Use of ASA/thienopyridine therapy

These medications can affect platelet function and increase the risk of bleeding.

76
Q

What are some conditions that can lead to anemia or thrombocytopenia?

A
  • Hereditary coagulopathies
  • Sickle cell disease

These conditions can affect blood cell production or function, leading to lower levels of red blood cells or platelets.

77
Q

What should be avoided in patients with sickle cell disease?

A
  • Hypoxia
  • Anemia
  • Dehydration

Avoiding these conditions is crucial to prevent complications in patients with sickle cell disease.

78
Q

What is the treatment for hemophilia?

A

Infusion of Factor VIII

Factor VIII is essential for blood clotting and its infusion helps manage bleeding episodes in hemophilia patients.

79
Q

What is von Willebrand disease treated with?

A
  • DDVAP
  • Humate infusion

These treatments help increase levels of von Willebrand factor and improve clotting in affected individuals.

81
Q

What is assessed in the level of consciousness during a physical examination?

A

Presence of neurological dysfunction and sensory or skeletal muscle dysfunction

Laughing instead of answering may indicate a lack of consent or altered mental status.

82
Q

What general impressions are made in the cardiovascular system assessment?

A

Baseline heart rate and auscultation of chest

Includes checking for normal heart sounds and abnormal murmurs.

83
Q

What are the abnormal sounds that may be heard during lung auscultation?

A

Rales, Rhonchi, Wheezing

Pre-op mini neb Rx may be considered.

84
Q

What factors can make intubation more challenging?

A

Limited flexion/extension and presence of a neck mass

A neck mass can cause tracheal deviation.

85
Q

What is the Mallampati classification used for?

A

Airway examination

It assesses the visibility of the oropharyngeal structures.

86
Q

What are the characteristics of a normal airway in adolescents and adults?

A
  • History of easy intubations
  • Normal appearing face
  • Normal clear voice
  • Absence of scars, burns, or swelling
  • Ability to lie supine asymptomatically
  • Patent nares
  • Ability to open the mouth widely
  • Mallampati class I
  • Adequate distance from mandible to thyroid notch
  • Slender supple neck
  • Movable larynx
  • Normal profile appearance

These factors indicate an easier intubation process.

87
Q

What is the incidence of difficult intubation in diabetic patients?

A

10 times higher

Limited joint mobility is present in 30-40% of IDDM patients.

88
Q

What hand position may indicate limited mobility in diabetic patients?

A

Prayer sign

Patients may be unable to straighten the 4th and 5th fingers.

89
Q

True or False: A history of radiation therapy to the head or neck is a characteristic of a normal airway.

A

False

A normal airway should have no history of radiation therapy.

90
Q

Fill in the blank: The ability to open the mouth widely is a characteristic of a normal airway, defined as a minimum of _______.

A

4 cm or three fingers held vertically in the mouth

Good TMJ function is also necessary.

91
Q

What is the normal extension angle for the atlantooccipital joint?

A

35°

This is important for assessing airway mobility.

92
Q

What is a factor characterizing difficult airway related to sleep?

A

OSA / History of snoring

OSA stands for Obstructive Sleep Apnea, which is a condition that can complicate airway management.

93
Q

What neck circumference indicates a potential difficult airway in men?

A

> 17 inches

Increased neck circumference is a risk factor for difficult intubation.

94
Q

What neck circumference indicates a potential difficult airway in women?

A

> 16 inches

This measurement is critical in assessing airway difficulties.

95
Q

What is the significance of thyro-mental distance in airway management?

A

Less than 7 cm with head in maximum extension

A smaller thyro-mental distance is associated with difficult intubation.

96
Q

What does a higher Mallampati score indicate?

A

Increased difficulty in airway management

Mallampati scores assess the visibility of the oropharyngeal structures.

97
Q

What term describes a large tongue that can complicate airway management?

A

Macroglossus

Macroglossus can obstruct the airway during intubation.

98
Q

What condition is characterized by the inability to protrude the mandible?

A

Limited mandibular protrusion

This can complicate airway access.

99
Q

Name a condition that can cause facial and neck deformities impacting airway management.

A

Previous surgery

Surgical alterations can affect airway anatomy.

100
Q

What is a risk factor related to previous medical history that complicates airway management?

A

Previous head and neck radiation

Radiation can lead to fibrosis and airway changes.

101
Q

What congenital condition is associated with difficult airway management?

A

Down syndrome

Down syndrome can involve anatomical variations affecting the airway.

102
Q

What is the Mallampati Class I?

A

P

This class indicates a potentially easier intubation.

103
Q

What is the Mallampati Class IV?

A

H

This class indicates a more difficult intubation scenario.

104
Q

What does the Cormack-Lehane scoring system evaluate?

A

Visibility of the glottis during laryngoscopy

It has four grades, with Grade 1 being the best visibility.

105
Q

What indicates a difficult intubation in terms of thyro-mental distance?

A

Distance < 7 cm or 3 finger breadths

Short thyro-mental distance correlates with difficult airway.

106
Q

What is the mandibular space’s role during laryngoscopy?

A

Accommodates tongue

Proper space is needed for effective visualization.

107
Q

What is the minimum sternomental distance for an easier intubation?

A

> 9 cm

This distance should be measured with the head in full extension.

108
Q

What does the acronym BURP stand for in airway management?

A

Back, Up, Right, Pressure

This maneuver can improve glottic opening during intubation.

109
Q

What is the interincisor distance used to assess?

A

Interdental gap

It helps in evaluating the ability to open the mouth for intubation.

110
Q

What functional aspect does interincisor distance evaluate?

A

TMJ function

Temporomandibular joint function is crucial for mouth opening.

111
Q

What position is evaluated for atlantooccipital function?

A

Sniffing Position

This position optimizes airway alignment for intubation.

112
Q

What is the Upper Lip Bite Test (ULBT)?

A

A technique for airway evaluation

113
Q

What drives routine preoperative testing?

A

The patient’s history and physical

114
Q

What are the risks of unwarranted testing?

A

Costly, may delay operation, increase risk for unneeded interventions

115
Q

When should diagnostic testing be indicated?

A

Only if it will correctly identify abnormality and change patient management

116
Q

What is the Choose Wisely Campaign?

A

A multidisciplinary collaboration to reduce unnecessary, costly procedures

117
Q

What are the ASA recommendations for pre-op testing in ASA I-II patients?

A

No baseline lab testing if blood loss and fluid shifts are minimal

118
Q

What is the recommendation for diagnostic cardiac testing in asymptomatic stable patients?

A

No diagnostic cardiac testing in known cardiac disease patients undergoing low-mod risk non-cardiac surgery

119
Q

What laboratory tests are commonly assessed preoperatively?

A

Hgb/HCT, coagulation studies, blood chemistries

120
Q

What surgical issues necessitate Hgb/HCT testing?

A
  • Large blood loss anticipated * Trauma
121
Q

What patient history factors are important for coagulation studies?

A
  • Increased bleeding * Hematologic disorders * Renal disease * Recent chemotherapy or radiation treatment * Use of anticoagulants
122
Q

What are common blood chemistries assessed during preoperative assessment?

A
  • Alcohol abuse * Cardiovascular disease * Renal disease * Diabetes: HbA1c * Malnutrition
123
Q

What is the purpose of conducting an EKG preoperatively?

A

To identify high-risk patients with previous MI or arrhythmia

124
Q

What is the value of EKG in asymptomatic patients?

A

Limited in detecting ischemia, poor predictor of peri-op complications

125
Q

What are the ABCs of interpreting a Chest X-ray?

A
  • A- Airways * B- Bones & soft tissues * C- Cardiac silhouette & Calcifications * D- Diaphragm * E- Effusions, Edges, ECG leads * F- Fields (lungs) & Foreign Bodies * G- Gastric bubble * H- Hila & mediastinum * I- Instruments, Impressions, Inference
126
Q

What is the risk-benefit analysis for routine CXR in asymptomatic patients under 75 years?

A

Risk greater than the benefit

127
Q

What are the key components of Pulmonary Function Tests?

A
  • Forced Vital Capacity (FVC) * FEV1
128
Q

What is the normal FEV1/FVC ratio?

129
Q

FVC and FEV1

in. Airway obstructions: ie asthma bronchitis

A

FVC- normal
FEV1- Decreased
FEV1/FVC- Decreased

130
Q

FVC/FEV1 in stiff lungs

pneumonia, pulmonary edema, pulm fibrosis

A

FVC- Decreased
FEV1- decreased
FEV1/FVC- somehow normal

131
Q

FVC/FEV1 with respiratory muscle weakness

ie: Myasthenia gravis, myopathies

A

FVC- decreased
FEV1- decreased
FEV1/FVC- somehow normal again

133
Q

What is the recommended hold period for daily GLP-1 receptor agonists before surgery?

A

Hold the medication on the day of surgery

Daily GLP-1 receptor agonists should be held on the day of surgery to minimize risks.

134
Q

What is the recommended hold period for weekly GLP-1 receptor agonists before surgery?

A

Hold the medication for one week prior to surgery

Weekly GLP-1 receptor agonists should be held for a week before surgery.

135
Q

What are traditional fasting periods before surgery?

A

No food, gum, or candy after midnight; clear liquids up to 2 hours pre-op

Traditional fasting guidelines include these restrictions to minimize aspiration risk.

136
Q

What is the value of NPO after midnight?

A

Minimizes the risk of pulmonary aspiration

NPO (nil per os) is crucial for reducing aspiration risk during anesthesia.

137
Q

List risk factors for pulmonary aspiration.

A
  • Extremes of age
  • Emergency cases
  • Esophageal surgical history
  • Recent meal
  • Decreased gastric emptying
  • Trauma
  • Pregnancy
  • Pain and distress
  • Decreased level of consciousness
  • Difficulty with airway

These factors increase the likelihood of regurgitation and aspiration during anesthesia.

138
Q

What is the maximum time for clear liquids before surgery?

A

Up to 2 hours pre-op

Clear liquids such as water, black coffee, tea, and apple juice are allowed until 2 hours before the procedure.

139
Q

How long before surgery can breast milk be consumed?

A

Up to 4 hours pre-op

Breast milk is permitted until 4 hours before surgery.

140
Q

How long before surgery can formula be consumed?

A

Up to 6 hours pre-op

Formula is allowed until 6 hours before surgery.

141
Q

What type of light meal is allowed up to 6 hours before surgery?

A

Tea/toast

A light meal such as tea and toast can be consumed until 6 hours before surgery.

142
Q

What medications should be taken before surgery?

A

All prescribed medications taken with a sip of water

Patients should take their prescribed medications with a small amount of water, even during fasting.

143
Q

What condition can GLP-1 receptor agonists cause that increases the risk during anesthesia?

A

Nausea, vomiting, and delayed gastric emptying

These effects can increase the risk of regurgitation and aspiration.

144
Q

What is the impact of chewing gum on gastric volume?

A

Can increase gastric volume

Chewing gum may lead to increased gastric contents, which is a consideration before surgical procedures.

145
Q

True or False: Anxiety is a risk factor for pulmonary aspiration.

A

True

Anxiety can contribute to increased risk factors during anesthesia.

146
Q

What condition is characterized by altered mechanically and increases aspiration risk?

A

Esophageal surgery

Previous esophageal surgery can change the anatomy and increase the risk of aspiration.

147
Q

Fill in the blank: Conditions such as _______ and _______ can alter GI motility and increase aspiration risk.

A

[exogenous medications], [opioids]

Certain medications can affect gastrointestinal motility and increase the risk of aspiration.

148
Q

What types of gastric contents increase the risk of aspiration?

A
  • Solid food
  • Milk products

The type and composition of gastric contents are critical factors in aspiration risk.

149
Q

What are some metabolic disorders that increase pulmonary aspiration risk?

A
  • Hypothyroidism
  • Chronic diabetes
  • Hepatic failure
  • Hyperglycemia
  • Obesity
  • Renal failure
  • Uremia

These conditions can affect gastric emptying and increase the likelihood of aspiration.

150
Q

What is the significance of considering the potential impact of surgery proceeding earlier than scheduled?

A

It may affect the fasting status of the patient

Early surgery could lead to the patient not being adequately fasted, increasing aspiration risk.

151
Q

List neurological sequelae that can increase the risk of pulmonary aspiration.

A
  • Developmental delays
  • Head injury
  • Hypotonia
  • Seizures

Neurological conditions can compromise airway protection and increase aspiration risk.

152
Q

What age extremes increase the risk of regurgitation and pulmonary aspiration during anesthesia?

A

<1 yr or > 70 yr

153
Q

List three conditions that increase the risk of pulmonary aspiration during anesthesia.

A
  • Anxiety
  • Ascites
  • Collagen vascular disease
154
Q

What is a common exogenous medication that alters GI motility and increases aspiration risk?

155
Q

True or False: The ASA Physical Status Classification System is based on surgical or anesthetic risk.

156
Q

What does ASA 5 indicate regarding a patient’s condition?

A

Needs OR or death

157
Q

Identify two non-ASA status factors that influence patient outcome.

A
  • Duration and invasiveness of procedure
  • Human error
158
Q

What factors should be considered when determining the anesthesia plan of care?

A
  • Physical status of the patient
  • Type, length, invasiveness of procedure
  • Patient preference
  • Anesthesia provider preference
  • Surgeon preference
  • ‘What to expect’
159
Q

What are some frequently occurring, minimal impact risks associated with general anesthesia?

A
  • Oral or dental damage
  • Sore throat
  • Hoarseness
  • PONV
  • Drowsiness/confusion
  • Urinary retention
160
Q

List two infrequently occurring, severe risks associated with general anesthesia.

A
  • Awareness
  • Organ failure
161
Q

What is a frequently occurring, minimal impact risk associated with regional anesthesia?

A

Prolonged numbness/weakness

162
Q

Fill in the blank: Jehovah’s Witnesses may refuse _______ for religious reasons.

A

blood products

163
Q

What should be outlined before a treatment refusal occurs?

A

Religious reasons

164
Q

Identify a life-threatening situation that may override patient rights.

A

DNR gets brought in AFTER the things happened emergently

165
Q

True or False: A pregnant minor is not considered an adult.

166
Q

What are the serious risks associated with anesthesia that should be disclosed?

A
  • Serious risks
  • Prevention and treatment of risk
167
Q

What is the impact of failed spinal technique in regional anesthesia?

A

May require conversion to GA

168
Q

What are Do Not Resuscitate (DNR) Orders?

A

Orders indicating that a patient should not receive resuscitation efforts in case of cardiac arrest.

DNR orders are often specific to the perioperative period and may require separate forms for patients going to the OR.

169
Q

What is a common protocol regarding DNR orders in the operating room?

A

DNR orders may require separate documentation for patients knowingly going to the OR.

There may be ways to circumvent DNR orders in certain situations.

170
Q

What types of consent documentation are recognized?

A

Written, verbal, or implied consent.

Each type serves different contexts and requirements.

171
Q

What is the purpose of informed consent?

A

To ensure that patients understand the risks, benefits, and alternatives of a procedure before agreeing to it.

Informed consent is a legal and ethical requirement in medical practice.

172
Q

What is required for consent of a minor child?

A

Consent must be obtained from a parent or legal guardian.

Minors are generally not considered capable of giving informed consent themselves.

173
Q

How is consent obtained for a patient with altered level of consciousness (LOC)?

A

Consent must be obtained from a legally authorized representative or guardian.

Patients with altered LOC may not be able to provide informed consent themselves.

174
Q

What considerations are there for consent of patients with limited intelligence?

A

Consent must involve a legally authorized representative or guardian, ensuring the patient understands as much as possible.

Special care must be taken to ensure the patient’s rights and understanding.

175
Q

What might prompt a change in anesthetic management?

A

Changes in the patient’s medical condition or preferences during the perioperative period.

Informed consent should also cover potential changes in management.

176
Q

Where can one find Stanford Emergency Manuals?

A

At https://web.stanford.edu/dept/anesthesia/em/epic-manual.pdf

These manuals serve as a resource for emergency protocols and guidelines.

177
Q

how many CM is 1 inch

A

2.54 cm = 1 inch

NUAN603-Overview of Anesthesia (8 decks)

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