Patient Preparation Flashcards
government oversite requires a preanesthesia evaluation by a qualified practitioner be completed within ____ of surgery
48 hours
why do we pre-op a patient?
- optimize patient care and satisfaction
- minimize perioperative morbidity and mortality
- minimize surgical delays
- determine postoperative disposition
- evaluate patient’s health
- formulate perianesthetic care plan
- communicate patient issues among providers
- educate patient to the perioperative process
3 types of risks?
- procedural
- patient
- anesthesia
procedural risk stratification
- low (<1%) = cataract, ambulatory, endoscopic
- intermediate (1-5%) = orthopedic, head and neck
- high (>5%) = major vascular surgery
**AHA now divides into low (<1%) and elevated (>1%)
EF of ___ is an ______
<30%
independent risk factor for MACE
2 types of perioperative myocardial injury
- transient cardiac contractile dysfunction (‘myocardial stunning’)
- acute MI
ischemia of ____ is associated with functional recovery
<20 minutes
cardiac biomarkers
- myoglobin (start 2h, peak 4h)
- troponin (start 4h, peak 24h)
- total CK (peak 16h)
- CK-MB (peak 24)
______ is the most obvious feature of MI and can occur within ____ of ischemia
contractile dysfunction
10-15 seconds
Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database
-operation specific risk analysis: CABG, valve, CABG + valve
EuroScore II
-not validates with combined CABG + valve
consistent cardiac surgery risk factors
-age > 60
-female
-LV function < 30%
body habitus
-reoperation
-type of surgery
-urgency of surgery
-CKD
-DM
algorithm for non-cardiac surgery
- is the surgery emergent
- identify unstable cardiac conditions
- estimate perioperative risk
- low risk = proceed to surgery
- high risk = assess METS status (>4 =proceed to surgery)
- will further cardiac testing affect the plan (no = proceed
- yes = proceed to testing
METS
basal metabolic rate
3.5 mL/O2/kg/min
criticism of revised cardiac risk index (RCRI)
- 6 factors
- not surgery specific: underestimates vascular surgical risk
levels/class of evidence
level:
1 = multiple RCT
2 = single RCT, non-randomized
3 = expert opinion, case studies
class: 1 = should be 2a = reasonable 2b = considered 3 = harmful, not
DES - timeline
-elective surgery at least 6 months, prefer 1 year
bare metal stents - timeline
- elective surgery at least 6 weeks
- 12 weeks if ACS
a patient having an acute coronary syndrome should wait ____ before elective noncardiac surgery
60 days
physiologic response after angioplasty
- arterial wall recoil
- arterial remodeling - wall contracts and lumen narrows
- neointimal hyperplasia
in-stent restenosis peaks at ______, stent thrombosis peaks at _____
4-12 months
within first 30 days
wall classifications during echo
- normal
- hypokinetic
- akinetic
- dyskinetic/aneurysmal (opposite movement)
mitral/aortic regurgitation: mild/moderate/severe
mild <30%
moderate 30-50%
severe >50%
mitral/aortic stenosis: mild/moderate/severe
mild >1.5
moderate 1-1.5
severe <1