Peri Operative Risk Flashcards
surgical risk depends on 3 factors
specific surg risks
pt clinical variables
exercise capacity 4+ Mets = less risk
john snow..
gave chloroform to queen Victoria while in labor
clover and hewitt
created standard of escellence and anesthetic societies in late 19ths century
cocaine was the..
first local anesthetic used for eyeball in late 1800
William halstead
used cocaine for regional blocks - became addict
lead to lidocaine, procaine etc
cardiac risk is measured by
RCRI - revised cardiac risk index
examples of low risk non cardiac surg
endoscopy, opthalamologic, dental, skin
intermediate risk
nonvascular major abdominal infrainguinal vascular carotid, head and neck orthopedic prostate
high risk surg
emergent
major thoracic
aortic or supra inguinal vascular surg
expect major fluid shifts or blood loss
RCRI is trying to predict…
MACE if a major coronary event will occur
what 4 things on RCRI would indicate a delay or cancellation
- unstable ACS (USA, AMI etc)
- decompensation HF, new HF, HF 4
- sig or new arrhythmia
- severe valvular dz: AS or sx MS
when a pt has an elevated risk for MACE what percent is that?
over 1% risk = elevated
goldmans criteria
high risk surg? hx ischemic hd hx CHF hx CVD pre-op insulin tx serum cr over 2 mg/dl
correlation between goldmans and RCRI
if more than 2 yes on goldmans that = over 5% of MACE ..which may require further eval
beta blockers and post op?
NO! do not start on beta blockers post op on non cardiac surgeries
what age increases risk PNA post op?
over 60
anesthesia for more than __ hours indicates higher risk PNA and resp failure
4 hr +
other RF for PNA and resp failure
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
osa means
obstructive sleep apnea
t/f mortalitiy and morbitiy may go up in pts with a low h and h
true
how to screen for bleeding risk?
if hx incomplete, unreliable get PT, PTT, and platelets
a heparin bridge is only recommended for..
high risk for stroke pts
___ is an independent RF for mortality
AKI - acute kidney injury
increases 10-30% for cardiac surg and 50 if hemodialysis is required
how to tx aki
maintain intravascular volume
avoid NSAIDS, contrast media, ACE/ARB?
