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
myocardial nuclear scintigraphy
more sensitive than stress test
cardiac computed tomography
only valid in patients with no known CAD
cardiac magnetic resonance imaging
myocardial scarring aneurysm evaluation EF heart mass RV evaluation
conduction pathway
- SA node
- IN pathways
- AV node
- IV conduction (LBB, RBB, purkinje fibers)
