Outpt Surgery Week 3 Flashcards
How much less is the cost for outpt surgery than inpatient?
five times less
Ex premature infants younger than how many weeks old is a contraindication to outpt surgery?
60 weeks post conceptual age
How many vials of dantrolene should be available?
> 36
Single greatest cause of unanticipated hospital admission?
surgical complications
mL amt of liposuction that can qualify a pt to go home?
Amt of liposuction where pt should consider staying over night?
3,000-5,000
Amt of liposuction that requires pt to stay overnight?
> 5,000
Solution used in liposuction that is infiltrating saline or LR mixture with dilute amounts of epi and lidocaine solution prior to suctioning?
tumescent
Safe levels of lidocaine?
35 mg/kg- 55mg/kg
3 functions of tumescent?
analgesia, hydro dissection, improve hemostasis
What volume liposuction can be done under local anesthesia?
small volume
Highest dose of lidocaine may not be safe in pts with what issue?
low protein or other conditions where metabolic byproducts of lido break down and reach toxic levels
Why are pts undergoing liposuction at a more increased risk of hypothermia?
less surface area to put Bair Hugger on
What is the intraoperative fluid ratio for liposuction?
(IV fluid + infiltrate)/aspirate 2:1 for the small volume group
Is anesthesia involved with only local is done by the surgeon for liposuction?
no
A peripheral nerve block would be done w what type of anesthesia?
general or MAC
What type of anesthesia is Exparel?
local wound infiltration
What type of anesthesia is not done in outpatient bc of lack of predictability?
regional= spinal or epidural
To be eligible for outpatient surgery, disease status should be well controlled for how long?
3 months
4 types of pts who should be scheduled earlier on in the day?
pediatrics, elderly, diabetics, longer surgeries
Is there a relationship between OSA and unplanned hospital admission?
no
Pts with OSA have a greater risk for what 3 things?
difficult intubation, needing more pressors, and needing more O2 in PACU
Is a pt at high risk for ambulatory surgery if MI was
yes
A pt is at high risk for ambulatory surgery if a BMS was placed
ASA must be d/c preop
3 absolute contraindications to outpt surgery?
no caregiver for 24 hours, delayed recovery anticipated, severe uncorrectable CV disease
Infant >__ months has less risk of respiratory complications and apnea?
6
How long does a URI delay surgery for adults?
6 weeks
Pt with RTI may be more likely to…?
hold breath, bronchospasm, cough, laryngospasm, be hypoxic, have atelectasis, pneumonia, stridor, or croup
H&P should be done w/in how many days from surgery?
30
When should a pregnancy test be done on a pt?
DOS if >13 years old until year after last menses or hysterectomy
When should an EKG be done on outpt pts?
METs50 years old or history of cardiac issues
Potassium should be obtained when and for whom?
7 days before surgery, those on diuretics or dig
How soon before surgery should Coumadin be d/c?
5 days
What is the 8, 6, 4, 2 rule?
8 hours before surgery if heavy meal, 6 hours for light meal, 4 hours for breast milk, and 2 hours for clear liquids
What is pt supposed to do w insulin pump?
just keep the basal rate
What is pt supposed to do about long acting insulin dose?
1/2 the dose the night before and hold AM dose
How undiagnosed is OSA?
80%
A pt in a surgery lasting > how many hours should receive a catheter?
3
In what type of surgery should you decrease fluid?
cataract
In those patients undergoing surgery of limited scope and who are low risk, which fluid therapy is better tolerated-liberal or restricted?
liberal
Are COX2 inhibitors effective in ambulatory surgery?
no
What ages have less PONV?
infants and elderly
Risk factors for PONV?
woman, nonsmoker, motion sickness, age, anxiety, opioids/pain, neostigmine >2.5 mg, hydration status, length of surgery, type of surgery
Weight based dose of Decadron?
0.1mg/kg
Dexamethasone decreases what 3 things?
N, pain, opioid consumption
What type of anesthesia is rarely used in outpt surgery bc of delay discharge?
spinal
What type of anesthesia is not an airway irritant?
Propofol/TIVA
3 benefits of propofol TIVA?
decreased PONV, not airway irritant, rapid recovery-clear head
Which IA transiently increases hr and and bp?
sevo
Which IA is associated with emergence delirum?
sevo
3 meds to reduce agitation from sevo?
prop, fent, and midazolam
This IA improves quality and safety of induction of anesthesia, facilitates faster recovery, and reduces overall costs?
N20
Which NMB does Suggamedex reverse?
Roc and Vec
4 benefits to using LMA?
decreased sore throat, hoarseness, coughing, and laryngospasm
3 reasons why ProSeal is used for outpt surgery?
modified to provide increased seal pressure, reduces gastric inflation, provides gastric drainage
High seal pressure can get up to what amt with the ProSeal?
up to 30 cm
Regular LMAs can withhold pressure or what amt?
15 cm
Stage of PACU that includes awakening, management of pain and nausea, and monitoring of HD stability?
Phase I
Stage of PACU that includes stable vital signs, minimal pain, minimal nausea, and ability to sit with minimal dizziness?
Phase II
Phase of PACU that includes being at home?
Phase III
What score determines if pt can be moved from Phase I to Phase II?
Aldrette
Complete recovery of pyschomotor skills requires how much time after surgery?
24-48 hours
All outpt centers should have what 3 things?
at least 36 vials of Dantrolene, surgeon have admitting privileges at hospital, and IV lipid emulsion 20%
Aldrete score consists of what 5 parameters?
activity, respiration, circulation, consciousness, oxygenation
Maximum score for Aldrete score?
10
Aldrete score of what makes the pt ok for d/c from Phase I/
9
