PERIOPERATIVE Flashcards
percentage of DVT patient’s go on to develop postphlebitic syndrome, a painful and debilitating chronic disorder
UP TO 30%
patients with nonfatal PE will develop chronic thromboembolic pulmonary hypertension and what percentage
5%
the recommended DVT prophylaxis for moderate risk procedure with no associated risk factors - EEG, 45-year-old male undergoing elective sigmoid colectomy for diverticular disease
pharmacologic prophylaxis with
low molecular weight heparin
or
low-dose unfractionated heparin is recommended.
The incidence of perioperative myocardial infarction after major noncardiac surgery in patients without evidence of cardiac disease is approximately
0.15%.
Functional capacity is considered excellent, good, vs poor with what criteria
excellent if the patient reaches greater than 10 metabolic equivalents (METs),
good if greater than 4 METs,
Climbing a flight or 2 of stairs, walking up a hill, walking at 4 mph (6.4 kph), running a short distance, mopping or scrubbing the floor, lifting heavy furniture, dancing, bowling, and playing doubles tennis are all examples of activities that require greater than 4 METs to perform.
poor if less than 4 METs.
The accepted accumulated dose of ionizing radiation during a pregnancy is
5–10 rad, with no single diagnostic study exceeding 5 rad.
A CT scan of the abdomen and pelvis has how much radiation to fetus
2–4 rad of exposure to a fetus;
Fetal radiation exposure during cholangiography is estimated to be
0.2–0.5 rad,
lain abdominal radiograph averages radiation doses of
p0.1–0.3 rad.
Radiopharmaceuticals, including technetium-99m, can be administered with fetal whole body radiation doses of less than
0.5 rad.
Epidural anesthesia/analgesia decreases rates of what complications
cardiac morbidity
heart failure,
myocardial infarction,
death.
Decreases in the incidence of acute renal failure, deep venous thrombosis, pulmonary embolism, decreased blood loss,
Epidural anesthesia/analgesia improves
pulmonary outcomes
reduced rates of pneumonia and hypoxemia.
reductions in vascular graft occlusions, transfusion requirements, intubation time, length of stay
Epidural anesthesia/analgesia supportive care needed
Routine bladder catheterization is not required for patients who have TEAA,
although if removed within 24 hours of placement, approximately 10% of patients will have urinary retention requiring at least 1 intermittent straight catheterization.
pneumothorax rate of subclavian vein central axis and morbidly obese patient versus ideal body weight
Although subclavian vein central access is more likely to be attempted in morbidly obese patients (47% vs. 15%), the incidence of pneumothorax is similar.
The incidence of perioperative myocardial infarction after major noncardiac surgery in patients without evidence of cardiac disease is approximately
0.15%.
In patients with a history of myocardial infarction, the risk ranges from
2.8% to 17.7%.
For patients with adequate functional capacity without symptoms or history of myocardial infarction, was recommended for cardiac preoperative evaluation
in-depth cardiac testing is not beneficial.
preoperative coronary revascularization is associated with its own morbidity and clearly does not fully protect the patient from a postoperative cardiac event.
Preoperative coronary revascularization may also significantly delay the planned noncardiac procedure, and in the case of coronary stent placement, continuation of antiplatelet agents such as aspirin and clopidogrel may be necessary for many months, further complicating matters.
Functional capacity is considered excellent if the patient reaches greater than
10 metabolic equivalents (METs),
good if greater than 4 METs, and poor if less than 4 METs. Climbing a flight or 2 of stairs, walking up a hill, walking at 4 mph (6.4 kph), running a short distance, mopping or scrubbing the floor, lifting heavy furniture, dancing, bowling, and playing doubles tennis are all examples of activities that require greater than 4 METs to perform.
This patient has no symptoms of cardiac disease. The patient has the risk factor of hypertension and, therefore, a 12-lead electrocardiogram is recommended. Because the patient performs at a moderate functional capacity (>4 METs), a 6-minute walk, stress test, or cardiac imaging exam is unnecessary.
In those patients without symptoms of cardiac disease who are of poor or unknown functional capacity, stress testing or cardiac imaging may be indicated. This would be determined by the number of active clinical risk factors and the surgery-specific cardiac risk of the procedure.
Functional capacity is considered good if the patient reaches greater than
good if greater than 4 METs,
Functional capacity is considered poor if the patient reaches greater than
and poor if less than 4 METs.
activities that require greater than 4 METs to perform.
Climbing a flight or 2 of stairs, walking up a hill, walking at 4 mph (6.4 kph), running a short distance, mopping or scrubbing the floor, lifting heavy furniture, dancing, bowling, and playing doubles tennis are all examples of
vitamin D deficiency with early - 3 month post gastric bypass with symptoms of
had several weeks of intractable vomiting and unstable gait.
nystagmus.
classic signs of thiamine (Vitamin B1) deficiency (Wernicke encephalopathy) with intractable vomiting, unstable gait, and ocular motor dysfunction.
The continued vomiting serves to exacerbate the thiamine deficiency.
Neurological impairment may become permanent if treatment is not implemented.
Multiple mineral deficiencies are possible after bariatric surgery, such as
deficiencies of iron, calcium, copper, and zinc as well as Vitamins B1, B12, D, and E.
symptomatic deficiencies in the postbariatric surgery patient are generally limited to: posterolateral myelopathy (Vitamin B12 and copper deficiency)
acute encephalopathy (thiamine or Vitamin B1 deficiency).
treatment thiamine deficiency and bariatric
Thiamine deficiency can develop over a period of weeks; however, replacement therapy is effective within hours to days. In acutely ill patients, thiamine should be administered 3 times per day and given intravenously when possible. Dosages of 100–500 mg 3 times per day are described. Oral therapy generally consists of 50–100 mg twice daily.
bridge therapy in patients with atrial fibrillation, generally
bridge therapy in patients with atrial fibrillation, generally warfarin is discontinued 5–6 days before the procedure, and fractionated or unfractionated heparin is subsequently started within 2–3 days.
Heparin and warfarin are generally restarted within 12–24 hours after the procedure, and the heparin subsequently discontinued once the international normalized ratio (INR) reaches therapeutic range.
The American Society of Gastrointestinal Endoscopists defines low-risk procedures as
upper or lower endoscopy with or without mucosal biopsy, endoscopic retrograde cholangiopancreatography without sphincterotomy, and endoscopic ultrasound without biopsy.
In these patients, if the INR is within therapeutic range, it is safe to continue warfarin throughout the periprocedural period without interruption!
Data suggest that colonoscopy with polypectomy of lesions less than 1 cm in diameter can be performed safely in patients therapeutically anticoagulated on warfarin.
The American Society of Gastrointestinal Endoscopists defines Procedures deemed high risk for bleeding what is anticoagulation recommendations
endoscopic polypectomy,
sphincterotomy,
dilation of benign or malignant strictures,
percutaneous endoscopic gastrostomy tube placement,
endoscopic ultrasound with fine needle aspiration or core needle biopsy.
discontinuation or reduction of the warfarin dose and bridge therapy with heparin should be considered optimal.
The most effective method to reduce recurrence after operative closure of a small bowel enterocutaneous fistula (ECF) is
segmental resection with primary anastomosis.
that oversewing or wedge repair of established ECF had a recurrence rate of 32.7% versus 18.4% with resection and anastomosis or anastomotic revision.
No data indicate that ECF closure using layered sutures and bioabsorbable mesh reduces fistula recurrence rate.
Similarly, the use of fibrin glue, either as a primary closure method or an adjunct to suture closure of an ECF, does not reduce ECF recurrence.
Additional measures to reduce ECF recurrence rate include
drainage of septic foci, adequate nutritional support, skin protection, and patience.
The efficacy of octreotide in the management of fistulous
The efficacy of postoperative octreotide in the management of ECF is not clear.
Preoperatively, octreotide may help to reduce fistula output; however, there is little evidence that octreotide or somatostatin increases the overall probability of spontaneous fistula closure.
