Perioperative Medicine Flashcards
What are risk factors for functional decline in hospitalized patients?
- Older age
- Frailty
- CI
- Poor mobility/function
- Low social function
- Depression
- Other geriatric syndromes
What are interventions to prevent functional decline in hospitalized older adults?
- Care models: HELP, ACE units
- Structural: handrails, clear hallways, large clocks and calendars
- Staffing: nursing education, ID rounds
- Patient based: family in care, early mobility, early PT/OT, geriatric consult, discharge planning, nutritional support
What are risk factors for post operative delirium? (13)
Underlying cognitive impairment
History of delirium
General anesthetic/duration of surgery
Older age
Underweight BMI<18.5
Male sex
Low education
Institutionalized
Polypharmacy
Smoker
More comorbidities
Higher ASA status
Higher pre op CRP
What are delirium prevention strategies for post op?
- Non pharm multicomponent
- Dexmedetomidine
- Bispectral index monitoring
- Early hip fracture surgery (within 6 hours)
- CGA for hip fracture
- Peripheral nerve block in hip fracture
What is the rate of preoperative overt stroke after non cardiac surgery?
<1%
Covert stroke more common
How often does cognitive decline in those with perioperative covert stroke and what does it increase risk of?
42%
Periop delirium, overt stroke, TIA
What is the evidence for CGA in surgery?
Hip Fracture
1. Reduce mortality, reduce discharge to inc LOC
2. Slightly reduce cost and LOS
3. No change in readmission, complications, delirium
Elective vascular
1. Reduce LOS, delirium, cardiac complications, b/b complications, discharge to higher level of care
What are the components of a pre operative checklist?
- GOC
- Assess cognition
- Screen depression
- Identify and manage risk factors for delirium
- Screen for substance dependence
- Document functional status, mobility, falls
- Determine frailty
- Assess nutrition
- Determine support system
- Perform pre-op cardiac evaluation
- Perform pre-op pulmonary evaluation
- Order appropriate diagnostic tests
- Med review
What are the components of a post op checklist?
- Delirium prevention
- Multimodal pain control
- Falls risk reduction
- Maintain nutrition
- UTI prevention
- Prevent functional decline
- Reduce pressure ulcers
What risk calculators are available?
GSCRI - geriatric sensitive perioperative cardiac risk index
NSQIP
Essential Frailty Toolset for TAVR
What are risk factors that indicate futility of TAVI?
Advanced dementia
Bedbound
Cachexia/sev sarcopenia
Disability for all/most ADLs
End stage renal, liver, lung, malignant disease
What lab can you order to inform cardiac risk?
BNP or NT-pro BNP
How often do you do a troponin in perioperative period?
Daily x 48-72 hours (if BNP 92+ or NT BNP 300+)
In perioperative period how often do you do an ECG?
PACU (if BNP 92+ or NT BNP 300+
What do you do with ASA peri op?
Stop 1 week before surgery
