Overview of Preoperative Assessment and Management

Question 1

Characteristics independently
associated with difficult mask ventilation

Answer 1

Age older than 55 years
Body mass index (BMI) greater than 26kg/m2
Lack of teeth
A beard
Snoring history

Question 2

How are Down Syndrome and Reumatoid Arthritis associated with a difficult direct laringoscopy? How to investigate?

Answer 2

Patients with Down syndrome or RA are at risk for atlantoaxial instability (AAI).

Flexion/extension cervical spine radiographs should be ordered

Question 3

When to delay a elective surgery due to hypertension?

Answer 3

In case of severe HTN (SBP > 180 mmHg or DBP > 110 mmHg

Question 4

Which antihypertensives may be discontinued 12-24 hrs before the surgery?

Answer 4

Angiotensine converting enzime inhibitors
Angiotensine receptors blockers

Question 5

In patients whithout acute Coronary syndrome, when to consider a pharmacologic stress testing for non cardiac surgery?

Answer 5

In patients with elevated risck of MACE ( >1% or RCRI >= 2) and < 4 METs

Question 6

In patients with stable CAD, PCI before non cardiac surgery is benefitial in symptomatic patients

T or F

Answer 6

F

There is no role for PCI for stable CAD before non cardiac surgery

Question 7

When to continue aspirin on the day of surgery?

Answer 7

• known vascular disease
• vascular stents
• before cataract surgery (if no bulbar block)
• before vascular surgery
• taken for secondary prophylaxis

Question 8

Which surgeries are at risk of bleeding in closed space?

Answer 8

• Intracranial neurosurgery
• Intramedullary canal surgery
• posterior eye chamber ophthalmic surgery

Question 9

When the patient that uses aspirin and clopidogrel should continue the use in the day of surgery (vital surgery that can not be postpone)?

Answer 9

• High risk situations:
  1) < 12 months after DES in ACS
  2) < 6 months after DES in stable CAD
  3) High risk stents: long (>36mm), proximal, overlapping, multiple stents, stents in crhonical total occlusions or in small vessels or bifurcated lesions

Contraindications: risk of bleeding in closed space

Question 10

How to manage the insulin intake in the day of surgery?

Answer 10

Type 1 DM: 1/3 of intermediate or long acting insulin

Type 2 DM: 1/2 of long acting insuline

Stop short acting insulin

Question 11

When dialytic patients should perform the dialysis in the context of a surgery?

Answer 11

24h before the surgery

Question 12

Which patients are at risk for delayed gastric emptying?

Answer 12

Morbid obesity
DM
Pregnancy
DRGE
Surgery limiting stomach capacity
Potencially difficult airway
Opiate analgesic therapy

Question 13

Aspirin needs to be discontinued in the day of surgery when a neuroaxial anesthesia is planned

V ou F

Answer 13

F

Question 14

After a ischemic stroke, for how long time the risk of MACE remains elevated?

Answer 14

Risk of MACE remains elevated for as long
as 9 months after an ischemic stroke