Patient Preparation

Question 1

government oversite requires a preanesthesia evaluation by a qualified practitioner be completed within ____ of surgery

Answer 1

48 hours

Question 2

why do we pre-op a patient?

Answer 2

• 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

Question 3

3 types of risks?

Answer 3

• procedural
• patient
• anesthesia

Question 4

procedural risk stratification

Answer 4

• 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%)

Question 5

EF of ___ is an ______

Answer 5

<30%

independent risk factor for MACE

Question 6

2 types of perioperative myocardial injury

Answer 6

• transient cardiac contractile dysfunction (‘myocardial stunning’)
• acute MI

Question 7

ischemia of ____ is associated with functional recovery

Answer 7

<20 minutes

Question 8

cardiac biomarkers

Answer 8

1. myoglobin (start 2h, peak 4h)
2. troponin (start 4h, peak 24h)
3. total CK (peak 16h)
4. CK-MB (peak 24)

Question 9

______ is the most obvious feature of MI and can occur within ____ of ischemia

Answer 9

contractile dysfunction

10-15 seconds

Question 10

Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database

Answer 10

-operation specific risk analysis: CABG, valve, CABG + valve

Question 11

EuroScore II

Answer 11

-not validates with combined CABG + valve

Question 12

consistent cardiac surgery risk factors

Answer 12

-age > 60
-female
-LV function < 30%
body habitus
-reoperation
-type of surgery
-urgency of surgery
-CKD
-DM

Question 13

algorithm for non-cardiac surgery

Answer 13

1. is the surgery emergent
2. identify unstable cardiac conditions
3. estimate perioperative risk
4. low risk = proceed to surgery
5. high risk = assess METS status (>4 =proceed to surgery)
6. will further cardiac testing affect the plan (no = proceed
7. yes = proceed to testing

Question 14

METS

Answer 14

basal metabolic rate

3.5 mL/O2/kg/min

Question 15

criticism of revised cardiac risk index (RCRI)

Answer 15

• 6 factors

- not surgery specific: underestimates vascular surgical risk

Question 16

levels/class of evidence

Answer 16

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

Question 17

DES - timeline

Answer 17

-elective surgery at least 6 months, prefer 1 year

Question 18

bare metal stents - timeline

Answer 18

• elective surgery at least 6 weeks

- 12 weeks if ACS

Question 19

a patient having an acute coronary syndrome should wait ____ before elective noncardiac surgery

Answer 19

60 days

Question 20

physiologic response after angioplasty

Answer 20

1. arterial wall recoil
2. arterial remodeling - wall contracts and lumen narrows
3. neointimal hyperplasia

Question 21

in-stent restenosis peaks at ______, stent thrombosis peaks at _____

Answer 21

4-12 months

within first 30 days

Question 22

wall classifications during echo

Answer 22

1. normal
2. hypokinetic
3. akinetic
4. dyskinetic/aneurysmal (opposite movement)

Question 23

mitral/aortic regurgitation: mild/moderate/severe

Answer 23

mild <30%
moderate 30-50%
severe >50%

Question 24

mitral/aortic stenosis: mild/moderate/severe

Answer 24

mild >1.5
moderate 1-1.5
severe <1

Question 25

myocardial nuclear scintigraphy

Answer 25

more sensitive than stress test

Question 26

cardiac computed tomography

Answer 26

only valid in patients with no known CAD

Question 27

cardiac magnetic resonance imaging

Answer 27

myocardial scarring
aneurysm evaluation 
EF
heart mass
RV evaluation

Question 28

conduction pathway

Answer 28

• SA node
• IN pathways
• AV node
• IV conduction (LBB, RBB, purkinje fibers)