Outpatient/Office Surgery

Question 1

Today’s trends in anesthesia

Answer 1

80% outpatient
$$ primary incentive for amb/office surgery
Meds- shorter acting

Question 2

When to perform safe surgery checklist

How many periods

Answer 2

1. Prior to admin of anesthesia
2. Prior to skin incision
3. Period of closure of incision & prior to pt leaving the OR

Question 3

SCIP measure

Answer 3

1. Temp
2. Abx
3. Beta blockers

Question 4

What is the goal of pre op eval

Answer 4

Identify at risk pts

Question 5

Who gets EKG

Answer 5

> 50 & has comorbidity or >50 & more invasive procedure

Question 6

What meds not to take day of surgery

Answer 6

Diuretics
MAO
Anticoagulant: Coumadin 5 days, plavix 7 days
PO DM meds
Herbal meds
Viagra, ETOH, cigarettes

Question 7

Which herbs potentials bleeding

Answer 7

Ginkgo, garlic, ginger, fish oil

Question 8

Hypokalemia is caused by what herb

Answer 8

Licorice

Question 9

Cardiac instability - herb??

Answer 9

Ephedra

Question 10

Prolong sedation herb

Answer 10

Kava

Question 11

Decrease BP herb

Answer 11

Black cohosh

Question 12

Increase BP, agitation, drowsiness

Answer 12

St. John’s wort

Question 13

CVA & MI criteria for ASC

Answer 13

CVA within 3 months
MI 0-3 months not in office
MI 3-6 moths needs clearance

Question 14

Geriatric pt

Answer 14

Physiologic age, not chronologic

Question 15

Pediatrics pt

Answer 15

Gestation >37 weeks healthy

>2-4 weeks old then OS is ok

Question 16

Preemies pt not recommended if

Answer 16

Preemie with post conceptual age of

Question 17

Monitoring for infants

Question 18

STOP

BANG

Answer 18

Snore
Tired
Observed that u stopped breathing
Pressure, high BP

BMI >35
Age >50
Neck circumference >40cm or 15.75 in
Gender male

Question 19

When do most OSA complication occur and waht to anticipate

Answer 19

Within 2 hrs of surgery

Anesthesia increases the number & duration of apnea periods
Anticipate longer phase II recovery stay
Median post d/c observation is 7 hrs

Question 20

What surgery to schedule first in am

Answer 20

Convulsive disorder
MH
DM 1
These pt need to be observe 4 hrs after surgery

Question 21

How long should surgery be delayed if URI present

Answer 21

Until 6 weeks have elapsed

Question 22

Fasting guidelines for healthy pt undergoing elective surgery

Answer 22

2 hrs - CL
4 hrs - breast milk,
6 hrs - formula, milk, light meal

Question 23

Common complication - delay of discharge

Answer 23

PONV 20-30%
Urinary retention
Hypothermia
Poor pain control
Itching
Sore throat

Question 24

Aldrete subgroups

Answer 24

Respiration
O2 sat
Consciousness
Circulation
Activity

Question 25

Airway equipment needed for offsite locations

Answer 25

Always: oxygen, sx, O2, ambu bag | Monitoring for transfer if unstable

Question 26

Office accreditations

Answer 26

JACHO AAAHC AAAASF

Question 27

The most common cause r/t injury/death

Answer 27

Inadequate ventilation/oxygenation

Question 28

Lipo consideration

Answer 28

EBL 1% of aspirat Limit to 5000 ml --1% ---50 ml Peak plasma lido ---- 12-14 hrs after injection

Question 29

What ASA for office procedures | Waht is the minimal age

Answer 29

Healthy 1 & 2 >3 years old

Question 30

Office surgery contraindications

Answer 30

``` Lipo/tumescent both >5000 ml Multiple procedures with abdomoplasty Anticipated blood loss >500ml Surgery > 6 hrs Unable to complete case by 3pm ```

Question 31

How to calculate O2 tank, remaining time

Answer 31

Time in Hrs = Oxygen cylinder pressure/200 x O2 flow rate(L/min) Time in min = 0.35 x psi on gauge/L per min to be delivered

Question 32

Disadvantages of office based practice

Answer 32

1. No consistent regulatory oversight 2. Crna responsible for maintainance 3. No emergency backup 4. Crna must be aware of state regulations

Question 33

Most common procedure outpatient

Answer 33

Cataract