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Surgery > Medical Risk Factors > Flashcards

Medical Risk Factors Flashcards

0
Q

Give what to renal-failure related anemia, anemia of chronic disease, autologous donation, refusal of transfusion

A

EPO

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1
Q

What may sickle cell patients develop and what should be maintained perioperatively

A

Cholelithiasis

Maintain hydration and oxygenation to avoid crisis

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2
Q

Tachycardia, oliguria, hypotension, fatigue, syncope, tachypnea, dyspnea, or TIA

A

Symptomatic anemia

Give tranfusion

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3
Q

Leading cause of death after anesthesia and surgery

A

Perioperative cardiac mortality

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4
Q

Recent MI, unstable angina
Decompensated CHF
Significant arrhythmias
Severe valvular disease

A

Major perioperative CV risk

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5
Q

Mild angina
Hx of MI or q waves
Compensated or hx of CHF
Diabetes

A

Intermediate perioperative CV risk

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6
Q 
Advanced age
Abnormal ECG
Other than sinus rhythm
Low functional capacity
Hx of stroke
Uncontrolled HTN
A

Minor perioperative CV risk

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7
Q

What type of anesthesia decreases postop MI

A

Peri and postop epidural versus general

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8
Q

Time frame of anticoagulant withdrawal

A

3 days preop

Restart 2-3 days postop

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9
Q

Give preoperatively to patients with increased cardiac risk

A

Beta-blockers

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10
Q

Dental, oral, respiratory, or esophageal procedure abx prophylaxis

A

Amoxicillin po
or Ampicillin IV

Allergic to PCN then clindamycin or cephalosporin

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11
Q

GI/GU procedure abx prophylaxis

A

High risk: ampicillin + gentamicin or vanc + gent

Moderate: amoxicillin or ampicillin or vancomycin

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12
Q

When to stop smoking before elective procedure

A

6 to 8 weeks

Risk of complications increases if >20 cigarettes per day or 20 pack/year history

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13
Q

Given for COPD, asthma to reduce complications (4)

A

antibiotics, bronchodilators (aminophylline), acetylcysteine, steroids

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14
Q

Which procedures decrease TLC, FRC, TV the greatest

A

Thoracotomy, upper abdominal surgery

for 1-2 weeks postop

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15
Q

3 most common pulmonary complications

A

Atelectasis, pulmonary infection, aspiration of gastric contents

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16
Q

Prophylaxis/Tx for aspiration of gastric contents

A

H2 blockers or PPI

Tx for large aspirates is bronchoscopy

17
Q

Preoperative considerations in chronic renal failure (3)

A

decreased GFR

change in volume and electrolyte homeostasis impaired metabolism/excretion of medications and dyes

18
Q

Studies for chronic renal failure (5)

A 
BMP
CBC (HCT)
Urinalysis
CXR
ECG
19
Q

Type of hyperparathyroidism in renal failure

A

Secondary

20
Q

Hematologic changes in renal failure

A

anemia, coagulation defect

21
Q

When is dialysis required

How long before surgery

A

When GFR is <5% of normal

24 hours before surgery

22
Q

Complication of peritoneal dialysis

A

peritonitis

23
Q

Complications of hemodialysis

A

worsened coagulopathy (heparin), staphylococcal infections

24
Q

Tx for hyperkalemia (>5 mEq/L) (5)

A 
IV calcium gluconate
Sodium bicarbonate
Insulin and glucose
Exchange resins (sodium polystyrene sulfonate)
Dialysis
25
Q

Tx for metabolic acidosis

A

Bicarbonate or dialysis

26
Q

Tx for coagulopathy (3)

A

Adequate dialysis
Withhold heparin
FFP or DDAVP

27
Q

What anesthetic is contraindicated in renal failure

Which one is preferred

A

Succinylcholine
Atracurium is preferred

Benzodiazepines will sedate for longer

28
Q

Labile blood pressure, impaired wound healing, postoperative hematomas, shunt thrombosis

A

Postop complications in renal failure patients

29
Q

Which tests confirm liver disease (8)

A

AST, ALT, bilirubin, alk phos, albumin, PT, BT, platelet count

30
Q

What do you need to confirm acute hepatitis

A

liver biopsy

31
Q

When to quit EtOH before elective surgery in alcoholic hepatitis

A

6 to 12 weeks

32
Q

Management of portal hypertension (3)

A

beta-blockers
octreotide
transvenous intrahepatic portosystemic shunting

33
Q

Procedures to decompress cholangitis

A

Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stenting
or transhepatic cholangicography (THC) with drainage

Prevents sepsis

34
Q

Obstructive jaundice causes which complications
Decreased Vit K absorption
Jaundice
Stress gastritis

A

Coagulation disorders
Acute renal failure
GI hemorrhage

35
Q

Best inhalant anesthetic for liver disease

A

Isoflurane

36
Q

Tx for increased PT (Vit K deficiency)

A

Vitamin K

FFP

37
Q

Why avoid narcotics and sedatives in liver patients

A

Can cause hepatic encephalopathy

38
Q

Tx of hepatic encephalopathy

A 
protein restriction
intestinal abx (neomycin)
lactulose
39
Q

Management of diabetes drugs preoperatively
Hypoglycemic agents
Sulfonylurea drugs
Metformin, why?

A

No hypoglycemics day of surgery
Withhold sulfonylurea 2-3 days before
Withhold metformin for 24 hours- risks lactic acidosis

40
Q

Tx for diabetic ketoacidosis

A

IV fluids
insulin
bicarbonate
potassium

41
Q

Postop complications in diabetics

A

Infection
Impaired wound healing
CV complications
Sepsis (staphylococcal)

Surgery (17 decks)

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