Medical Risk Factors Flashcards
Give what to renal-failure related anemia, anemia of chronic disease, autologous donation, refusal of transfusion
EPO
What may sickle cell patients develop and what should be maintained perioperatively
Cholelithiasis
Maintain hydration and oxygenation to avoid crisis
Tachycardia, oliguria, hypotension, fatigue, syncope, tachypnea, dyspnea, or TIA
Symptomatic anemia
Give tranfusion
Leading cause of death after anesthesia and surgery
Perioperative cardiac mortality
Recent MI, unstable angina
Decompensated CHF
Significant arrhythmias
Severe valvular disease
Major perioperative CV risk
Mild angina
Hx of MI or q waves
Compensated or hx of CHF
Diabetes
Intermediate perioperative CV risk
Advanced age Abnormal ECG Other than sinus rhythm Low functional capacity Hx of stroke Uncontrolled HTN
Minor perioperative CV risk
What type of anesthesia decreases postop MI
Peri and postop epidural versus general
Time frame of anticoagulant withdrawal
3 days preop
Restart 2-3 days postop
Give preoperatively to patients with increased cardiac risk
Beta-blockers
Dental, oral, respiratory, or esophageal procedure abx prophylaxis
Amoxicillin po
or Ampicillin IV
Allergic to PCN then clindamycin or cephalosporin
GI/GU procedure abx prophylaxis
High risk: ampicillin + gentamicin or vanc + gent
Moderate: amoxicillin or ampicillin or vancomycin
When to stop smoking before elective procedure
6 to 8 weeks
Risk of complications increases if >20 cigarettes per day or 20 pack/year history
Given for COPD, asthma to reduce complications (4)
antibiotics, bronchodilators (aminophylline), acetylcysteine, steroids
Which procedures decrease TLC, FRC, TV the greatest
Thoracotomy, upper abdominal surgery
for 1-2 weeks postop
3 most common pulmonary complications
Atelectasis, pulmonary infection, aspiration of gastric contents
Prophylaxis/Tx for aspiration of gastric contents
H2 blockers or PPI
Tx for large aspirates is bronchoscopy
Preoperative considerations in chronic renal failure (3)
decreased GFR
change in volume and electrolyte homeostasis impaired metabolism/excretion of medications and dyes
Studies for chronic renal failure (5)
BMP CBC (HCT) Urinalysis CXR ECG
Type of hyperparathyroidism in renal failure
Secondary
Hematologic changes in renal failure
anemia, coagulation defect
When is dialysis required
How long before surgery
When GFR is <5% of normal
24 hours before surgery
Complication of peritoneal dialysis
peritonitis
Complications of hemodialysis
worsened coagulopathy (heparin), staphylococcal infections
Tx for hyperkalemia (>5 mEq/L) (5)
IV calcium gluconate Sodium bicarbonate Insulin and glucose Exchange resins (sodium polystyrene sulfonate) Dialysis
Tx for metabolic acidosis
Bicarbonate or dialysis
Tx for coagulopathy (3)
Adequate dialysis
Withhold heparin
FFP or DDAVP
What anesthetic is contraindicated in renal failure
Which one is preferred
Succinylcholine
Atracurium is preferred
Benzodiazepines will sedate for longer
Labile blood pressure, impaired wound healing, postoperative hematomas, shunt thrombosis
Postop complications in renal failure patients
Which tests confirm liver disease (8)
AST, ALT, bilirubin, alk phos, albumin, PT, BT, platelet count
What do you need to confirm acute hepatitis
liver biopsy
When to quit EtOH before elective surgery in alcoholic hepatitis
6 to 12 weeks
Management of portal hypertension (3)
beta-blockers
octreotide
transvenous intrahepatic portosystemic shunting
Procedures to decompress cholangitis
Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stenting
or transhepatic cholangicography (THC) with drainage
Prevents sepsis
Obstructive jaundice causes which complications
Decreased Vit K absorption
Jaundice
Stress gastritis
Coagulation disorders
Acute renal failure
GI hemorrhage
Best inhalant anesthetic for liver disease
Isoflurane
Tx for increased PT (Vit K deficiency)
Vitamin K
FFP
Why avoid narcotics and sedatives in liver patients
Can cause hepatic encephalopathy
Tx of hepatic encephalopathy
protein restriction intestinal abx (neomycin) lactulose
Management of diabetes drugs preoperatively
Hypoglycemic agents
Sulfonylurea drugs
Metformin, why?
No hypoglycemics day of surgery
Withhold sulfonylurea 2-3 days before
Withhold metformin for 24 hours- risks lactic acidosis
Tx for diabetic ketoacidosis
IV fluids
insulin
bicarbonate
potassium
Postop complications in diabetics
Infection
Impaired wound healing
CV complications
Sepsis (staphylococcal)
