Perioperative considerations for Foot and Ankle Surgery Flashcards
Describe the American Society of Anesthesiologis classification of physical status
ASA
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.
What four diagnostic tests can be ordered as part of a vascular work up?
Doppler with segmental pressures.
Ankle/Arm indices
Transcutaneous oximetry
Angiography (MRI)
How many millileters a day are normal adults expected to intake?
1600 mL per day.
500 from water
800 from food
300 from oxidation
which form of IV is closest in composition to plasma?
Lactated ringers.
What is the bag D5 used for IV?
Adds 50 gm of glucose per liter.
D5W is dextrose in water for diabetics.
At what blood glucose levels will wound healing be delayed?
when above 200 in diabetics.
What effect does albumin have on healin?
Low levels of albumin inhibit wound healing!
what dosage of insulin should be given before surgery for a diabetic patient?
Give one half insulin dose preoperatively and second half of insulin after surgery.
Provide D5W as well.
When should aspirin be stopped prior to surgery?
Stop ASA 2 weeks before
When should NSAIDS be removed before surgery?
3-5 days before surgery.
If a patient is taking oral cortisone, when should you have to supplement?
Do not need to supplement if < 5.0 mg/day or intra articular injection!
Name the stress dose of corticosteroids for patients on long term steroid therapy when getting…
Minor hernia
Moderate surgery type
Major surgery type
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
Which two prophylactic antibiotics can be used before surgery?
1-2 gm Ancef IV 30 minutes before surgery
1 gm vancomycin IV 1 hour before surgery.
When should coumadin be stopped before surgery?
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.
what is the reversal drug for heparin?
Protamine sulfate.
What should be given to patients with gout risk before surgery?
Oral colchicine 0.6mg Bid two days before surgery and one day post operatively.
When should you avoid surgery in a cardiovascular patient?
Avoid elective surgery if the patient has had an MI within the last 6 months!!!
Consult cardiac.
Why should you be weary of patients that have rheumatic heart disease and mitral valve prolapse?
These patients are prone to bacterial endocarditis.
Prophylax these patients with amoxicillin before hand!
Which inhaled hypnotic should be avoided in patients with hepatic disease?
Halothanes and amides as they are metabolized by the liver.
Which local anesthetic choices should be avoided in patients with liver disease?
Amides as they are metabolized by the liver.
What is clarks rule for pediatric dosing of medications?
Weight / 150 this is the fraction of the adult dose to give!!!
