Peri Operative Risk

Question 1

surgical risk depends on 3 factors

Answer 1

specific surg risks
pt clinical variables
exercise capacity 4+ Mets = less risk

Question 2

john snow..

Answer 2

gave chloroform to queen Victoria while in labor

Question 3

clover and hewitt

Answer 3

created standard of escellence and anesthetic societies in late 19ths century

Question 4

cocaine was the..

Answer 4

first local anesthetic used for eyeball in late 1800

Question 5

William halstead

Answer 5

used cocaine for regional blocks - became addict

lead to lidocaine, procaine etc

Question 6

cardiac risk is measured by

Answer 6

RCRI - revised cardiac risk index

Question 7

examples of low risk non cardiac surg

Answer 7

endoscopy, opthalamologic, dental, skin

Question 8

intermediate risk

Answer 8

nonvascular major abdominal 
infrainguinal vascular 
carotid, head and neck 
orthopedic 
prostate

Question 9

high risk surg

Answer 9

emergent
major thoracic
aortic or supra inguinal vascular surg

expect major fluid shifts or blood loss

Question 10

RCRI is trying to predict…

Answer 10

MACE if a major coronary event will occur

Question 11

what 4 things on RCRI would indicate a delay or cancellation

Answer 11

1. unstable ACS (USA, AMI etc)
2. decompensation HF, new HF, HF 4
3. sig or new arrhythmia
4. severe valvular dz: AS or sx MS

Question 12

when a pt has an elevated risk for MACE what percent is that?

Answer 12

over 1% risk = elevated

Question 13

goldmans criteria

Answer 13

high risk surg? 
hx ischemic hd 
hx CHF 
hx CVD 
pre-op insulin tx 
serum cr over 2 mg/dl

Question 14

correlation between goldmans and RCRI

Answer 14

if more than 2 yes on goldmans that = over 5% of MACE ..which may require further eval

Question 15

beta blockers and post op?

Answer 15

NO! do not start on beta blockers post op on non cardiac surgeries

Question 16

what age increases risk PNA post op?

Answer 16

over 60

Question 17

anesthesia for more than __ hours indicates higher risk PNA and resp failure

Answer 17

4 hr +

Question 18

other RF for PNA and resp failure

Answer 18

upper abdominal and CT procedures 
prolonged anesthesia over  4 hr 
age over 60 
tobacco abuse over 20 pack years 
COPD/ HF/ OSA/ Pre-op sepsis 
hypoalbuminemia 
impaired congition

Question 19

osa means

Answer 19

obstructive sleep apnea

Question 20

t/f mortalitiy and morbitiy may go up in pts with a low h and h

Answer 20

true

Question 21

how to screen for bleeding risk?

Answer 21

if hx incomplete, unreliable get PT, PTT, and platelets

Question 22

a heparin bridge is only recommended for..

Answer 22

high risk for stroke pts

Question 23

___ is an independent RF for mortality

Answer 23

AKI - acute kidney injury

increases 10-30% for cardiac surg and 50 if hemodialysis is required

Question 24

how to tx aki

Answer 24

maintain intravascular volume

avoid NSAIDS, contrast media, ACE/ARB?

Question 25

what is major pre op survey focused on

Answer 25

cardiopulmonary helath of pt

Question 26

thyromental distance want it over..

Answer 26

6.5 to 7 cm

Question 27

who do you get a pre op 12 lead ekg on?

Answer 27

asymotpatic women over 50 or men over 45

anyone with known cardiac hx

Question 28

in pts with known CAD and poor functional status guielines call for..

Answer 28

non invasive stress testing - pet scan

Question 29

examples of minor predictors or RF for CVD (but considered independent factors for mortality)

Answer 29

70+
abnormal ekg
uncontrolled HTN
other than sinus rhythm (ie a fib)