Perioperative considerations for Foot and Ankle Surgery

Question 1

Describe the American Society of Anesthesiologis classification of physical status

ASA

Answer 1

ASA 1 Normal
ASA 2 Mild systemic disease (diabetes)
ASA 3 Severe systemic disease limiting activity but not incapacitating.

ASA 4 Incapacitating systemic disease.

ASA 5 Moribund not expected to survive

E is emergency surgical procedure.

Question 2

What four diagnostic tests can be ordered as part of a vascular work up?

Answer 2

Doppler with segmental pressures.

Ankle/Arm indices

Transcutaneous oximetry

Angiography (MRI)

Question 3

How many millileters a day are normal adults expected to intake?

Answer 3

1600 mL per day.

500 from water
800 from food
300 from oxidation

Question 4

which form of IV is closest in composition to plasma?

Answer 4

Lactated ringers.

Question 5

What is the bag D5 used for IV?

Answer 5

Adds 50 gm of glucose per liter.

D5W is dextrose in water for diabetics.

Question 6

At what blood glucose levels will wound healing be delayed?

Answer 6

when above 200 in diabetics.

Question 7

What effect does albumin have on healin?

Answer 7

Low levels of albumin inhibit wound healing!

Question 8

what dosage of insulin should be given before surgery for a diabetic patient?

Answer 8

Give one half insulin dose preoperatively and second half of insulin after surgery.

Provide D5W as well.

Question 9

When should aspirin be stopped prior to surgery?

Answer 9

Stop ASA 2 weeks before

Question 10

When should NSAIDS be removed before surgery?

Answer 10

3-5 days before surgery.

Question 11

If a patient is taking oral cortisone, when should you have to supplement?

Answer 11

Do not need to supplement if < 5.0 mg/day or intra articular injection!

Question 12

Name the stress dose of corticosteroids for patients on long term steroid therapy when getting…

Minor hernia

Moderate surgery type

Major surgery type

Answer 12

Minor types use 25 mg/day for 1 day.

Moderate types use 50-75 mg/day for 1-2 days.

Major types use 100-150 mg/day for 2-3

Question 13

Which two prophylactic antibiotics can be used before surgery?

Answer 13

1-2 gm Ancef IV 30 minutes before surgery

1 gm vancomycin IV 1 hour before surgery.

Question 14

When should coumadin be stopped before surgery?

Answer 14

Stop coumadin 3-5 days prior to surgery.

Can start on heparin or lovenox

start up coumadin 3-5 days post op until the PT is therapeutic.

Question 15

what is the reversal drug for heparin?

Answer 15

Protamine sulfate.

Question 16

What should be given to patients with gout risk before surgery?

Answer 16

Oral colchicine 0.6mg Bid two days before surgery and one day post operatively.

Question 17

When should you avoid surgery in a cardiovascular patient?

Answer 17

Avoid elective surgery if the patient has had an MI within the last 6 months!!!

Consult cardiac.

Question 18

Why should you be weary of patients that have rheumatic heart disease and mitral valve prolapse?

Answer 18

These patients are prone to bacterial endocarditis.

Prophylax these patients with amoxicillin before hand!

Question 19

Which inhaled hypnotic should be avoided in patients with hepatic disease?

Answer 19

Halothanes and amides as they are metabolized by the liver.

Question 20

Which local anesthetic choices should be avoided in patients with liver disease?

Answer 20

Amides as they are metabolized by the liver.

Question 21

What is clarks rule for pediatric dosing of medications?

Answer 21

Weight / 150 this is the fraction of the adult dose to give!!!