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Diagnosis and Management > Pre-Op > Flashcards

Pre-Op Flashcards

1
Q

Learning Objectives

A
  1. State the key components of the Perianesthesia evaluation and how it fosters a safe surgical procedure
  2. Discuss the prime essential elements of the preoperative interview
  3. Define the ASA Physical Status Classification and its use
  4. Identify advantages and disadvantages of general anesthesia
  5. List the indications for regional block administration
  6. Locate the dermatome levels anatomically
  7. Describe various care principles such as preop testing and NPO guidelines
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2
Q

What is the purpose of the Preop Assessment?

A
  • To reduce morbidity and mortality asctd w surgery to prevent longer hospitalization and unnecessary cancellations*
  • TO OPTIMIZE PATIENTS*
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3
Q

Purpose of Preoperative Assessment

  • Prepares patient ph_____ and m_____ for surgical procedure
  • Obtain d______ tests and con_____ as needed
  • Decreases potential de____ and can______ the day of surgery
  • Identify and addresses potential pr_____ before the day of surgery
  • Great time for preoperative patient t_____
A
  • Prepares patient physically and mentally for surgical procedure
  • Obtain diagnostic tests and consultation as needed
  • Decreases potential delays and cancellations the day of surgery
  • Identify and addresses potential problems before the day of surgery
  • Great time for preoperative patient teaching
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4
Q

Preanesthesia Evaluation and Goals

  • Informs patient of the r___, b_____, and al_____ so that an informed con____ can be obtained
  • Educates the patient regarding the plan of an______ care as well as perioperative events
  • Assess if the patient is clinically op______ for planned surgical procedure
A
  • Informs patient of the risk, benefit, and alternatives so that an informed consent can be obtained
  • Educates the patient regarding the plan of anesthesia care as well as perioperative events
  • Assess if the patient is clinically optimized for planned surgical procedure
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5
Q

Types of Preoperative Assessments

(3)

A
  1. Surgicenter/Hospital face to face interviews
  2. Telephone interview
  3. Web based survey questionnaires
  • however cannot do PE and labs with telephone interview
  • however elderly, non-tech savy may be difficult to do web based preop assessment
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6
Q

Preop Physical Assessment

  • A__ - Linear increase in surgical risk resulting from increase comorbidities
  • H_____/Actual W_____/V___ signs (for baseline)
  • Em____ support to patient and family
  • Assess patients und______ of preoperative instructions and teachings-opportunity for questions
  • Discuss advance d______
  • Identify essential ____ work or diagnostic work up
    • Serum or Urine H_ _
A
  • Age - Linear increase in surgical risk resulting from increase comorbidities
  • Height/Actual Weight/Vital signs (for baseline)
    • Actual weight* (not what they want to it to be) important to calc med dosages
  • Emotional support to patient and family
  • Assess patients understanding of preoperative instructions and teachings-opportunity for questions
  • Discuss advance directives
  • Identify essential lab work or diagnostic work up
    • Serum or Urine H _ _
  • Not all pts need preop labs, labs will be reviewed by PCP, anesthesia, and surgeon
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7
Q

Preoperative Physical Assessment

  • Medication history (pr_____ and O__/H_____)
  • Nut_____ status
  • Cog_____ assessment
  • Lan____ barriers
  • Cul_____/Soc____ assessment Complete ROS-documenting and reporting abnormal findings
A
  • Medication history (prescribed and OTC/Herbal)
  • Nutritional status
  • Cognitive assessment
  • Language barriers
  • Cultural/Social assessment Complete ROS-documenting and reporting abnormal findings
  • Herbal meds like “The G’s” - ginkgo, ginger, garlic*
  • Check albumin for nutritional status (many drugs attach to albumin)*
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8
Q

Herbal Medications

  • Ephedra = (2)
  • Garlic, Fish Oil, Alfalfa, Ginger =
  • St. Johns Wort =
  • Kava Kava =
  • Valerian =
  • Gingko =
  • Viagra =
  • All these meds should be held how long before surgery?*
  • How about viagra, cialis?*
A
  • Ephedra = arrhythmias, HTN
  • Garlic, Fish Oil, Alfalfa, Ginger = Increased bleeding
  • St. Johns Wort = Prolonged anesthesia effects
  • Kava Kava = Potentiates benzodiazepines
  • Valerian = Decreases symptoms of Benzos
  • Gingko = May enhance bleeding
  • Viagra = Releases Nitric Oxide
  • All these meds should be held 7 days before surgery*
  • Viagra stop 24hrs before surgery, Cialis stop 48hrs before*
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9
Q

Previous response to Anesthetics

  • A____ reactions (include l____)
  • Delayed aw_____, Prolonged muscle par_____
  • Nausea and Vomiting (ONFM)* =
  • H____ness, My____
  • Developed high f____ during surgery
  • Adverse response in rel_____
A
  • Allergies/Allergic reactions (include latex)
  • Delayed awakening, Prolonged muscle paralysis
  • Nausea and Vomiting (ONFM)* = Opioids, Nonsmoker, Female, Motion Sickness Hx
  • Hoarseness, Myalgia
  • Developed high fever during surgery
  • Adverse response in relatives
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10
Q

Previous Adverse Response to Anesthetics Notes

Important to ask about allergies bc (2) abx often used in OR

ONFM risk associated with each factor?

Treatment of PONV?

A

Cefazolin and Ancef often used in OR

Opioids, Nonsmoker, Female, Motion sickness Hx

  • Each letter = 20% chance of post op NV
  • Ex) Female nonsmoker who takes opioids = 80% of post op N/V

Triple Therapy Tx = ie scopolamine patch (muscarinic) before surgery, decadron during, zofran (5HT3 receptor)

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11
Q

What is the most common post-op complication affecting ⅓ of the surgical population?

A

Post Op Nausea Vomiting (PONV)

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12
Q

Food Allergy Correlation and Hypersensitivity to Latex

  1. B
  2. A
  3. K
  4. Ch
  5. Pl
  6. P
  7. Ch
  8. P
  9. T
  10. Po
  11. F
  12. Ap
A
  1. Banana
  2. Avocado
  3. Kiwi
  4. Chestnut
  5. Plum
  6. Peach
  7. Cherry
  8. Papaya
  9. Tomato
  10. Potato
  11. Figs
  12. Apricots
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13
Q

Essential Areas Requiring Attention in Preop Interview

Which body systems (10)

A
  1. CNS
  2. CV
  3. Pulmonary
  4. Hepatic
  5. Renal
  6. Endocrine
  7. Heme/Coags
  8. Skeletal Muscle
  9. Reproductive
  10. Dentition
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14
Q

CNS

  • Cerebrovascular insufficiency (2)
  • S_____
    • If on meds- make sure _____ lvls
A
  • Cerebrovascular insufficiency (CVA/TIA)
  • Seizures
    • If on anti-seizure meds- make sure therapeutic lvls
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15
Q

CV

  • Ex_____ tolerance
  • An____ or chest pain
  • Hx MI = what is the rule?
  • H___ (treated and compliant), val___ disease
  • Tachydys_____/AICD =
  • Recent drug abuse?? =
A
  • Exercise tolerance
  • Angina or chest pain
  • Hx MI = If past MI in last 3m → usually wait about 6m before any procedure to reduce risk of CV complications post-op
  • HTN (treated and compliant), valvular disease
  • Tachydysrhythmias/AICD (automated implantable cardiac defibrillator)
  • Recent drug abuse?? = If recent drug abuse - won’t get surgery bc lots of street drugs interact with anesthesia drugs (lots of CI literature that says if you should cancel or not)
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16
Q

Pulmonary

  • (2)nea
  • Cough with s_____ production
  • As____/C____ - what to do?
  • Pn_____
  • Sm_____ history
  • Sleep _____
  • Recent URI- treated? do you have to hold surgery?
A
  • Dyspnea or orthopnea
  • Cough with sputum production
  • Asthma/COPD
    • Asthma/COPD = do we have a recept PFT if they’ve had a recent exacerbation (will also need referral to pulm)
  • Pneumonia
  • Smoking history
  • Sleep Apnea
  • Recent URI- treated?

We don’t cancel procedures anymore for URI (not lower just upper congestion, afebrile, runny nose)

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17
Q

Hepatic and Renal

Hepatic

  • J_______
  • Consuption of E_____
  • Hepa____

Renal

  • D______, Renal in_____
    • Dialysis pts = make sure __ and __ in optimal range
A

Hepatic

  • Jaundice
  • Consuption of ETOH
  • Hepatitis

Renal

  • Dialysis, Renal insufficiency
    • Dialysis pts = make sure K and Na in optimal range
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18
Q

Endocrine

  • D_
  • Th_____ pathology
  • Ad____ gland dysfunction
A
  • DM
  • Thyroid pathology
  • Adrenal gland dysfunction
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19
Q

Coagulation disorders/Hematologic

  • Coagulo_______ or in family
  • Br_____/bl____ easily
A
  • Coagulopathies or in family
  • Bruises/bleeds easily
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20
Q

Skeletal Muscle

  • A_____, osteo_____
  • W____ness
A
  • Arthritis, osteoporosis
  • Weakness
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21
Q

Reproductive

  • Ch____ bearing age, men____ history
  • Pr_____
A
  • Child bearing age, menstrual history
  • Pregnancy
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22
Q

Dentition

Why is dentition important?

  • M______, L_____, Pr______ Teeth
  • C___, Ven_____, Br____, Den____
  • Anything r_____able
  • Fangs, canines (if present…___)
A

Dentition is a biggie bc anything removable or protruding bc when using instrumentation - if knocks tooth into bronchus can cause embolus

  • Missing, Loose, Protruding Teeth
  • Caps, Veneers, Bridges, Dentures
  • Anything removable
  • Fangs, canines (if present…run)
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23
Q

What is the most #1 risk factor before going into surgery?

Elective patients should be?

A

History of Myocardial Infarction

Delay 6 months POST MI to reduce perioperative morbidity

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24
Q

Testing in Perioperative Setting

What labs/diagnostic tests to collect?

(5)

A

CBC

Coags

BMP

EKG

Chest Radiography

PFTs

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25
Q

CBC: Hemoglobin/HCT

  • What level should surgical patient’s Hgb be?
  • Patients with (2) may need to be cleared by hematology
A
  • Cardiac surgery patients should have a hemoglobin level >7g/dL to reduce cardiac complications as a result of surgery. Transfuse for Hgb of 7 or less
  • Patients with anemia or thrombocytopenia prior to major surgery may need to be seen and cleared by hematology
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26
Q

Platelet Count

  • > ____ for most surgical cases
  • > ____ for neurosurgery and ocular procedures
  • > ____ for epidural anesthesia
A
  • >50k for most surgical cases
  • >100k for neurosurgery and ocular procedures
  • >80k for epidural anesthesia bc we don’t want them to develop a hematoma in spinal cord that causes compression
  • Book says 50k but we like 90k
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27
Q

Coagulation Studies

Do you always need coag studies?

A

No, only perform if clinically indicated by H&P exam

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28
Q

Basic Metabolic Profile (BMP)

When should you get a BMP?

Especially (2)

A

Recommend to obtain for routine screening on patients with coexisting disease

Especially Diabetics and renal patients

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29
Q

EKG

Should we get an EKG on everyone?

A

Routine screening asymptomatic patients undergoing low risk surgery is not recommended

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30
Q

Chest Xray

Should we get a Cxray on everyone?

A

Warranted based on scheduled surgical procedure

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31
Q

Pulmonary Function Tests

Do we get PFTs for everyone?

A

Not routine screening

May be required for lung surgery or pt has underlying history of COPD or surgery is dependent on lung volume measurements

32
Q

Airway Assessment

=

A

Will usually check airways by looking in the mouth preop for everyone incase they need to be intubated

33
Q

Medications to be held 7 days before surgery

(5)

A
  1. Clopidogrel (Plavix)
  2. Herbal supplements
  3. Aspirin
  4. Garlic tablets
  5. Vitamins

Must consult with cardiologist for important meds such as plavix before dc’ing

34
Q

Medications to hold 5 days before surgery?

(1)

A

Coumadin (Warfarin)

35
Q

Medications to hold 3 days before surgery?

(1)

A

NSAID’s

36
Q

Medications to hold 1 days before surgery?

(2)

A

Lovenox

ASA (however can be continued for most surgical procedures)

37
Q

Medications to hold the day of surgery?

(3)

A
  • Diuretics (Hold diuretic bc don’t want them to pee during surgery and get a UTI)
  • Oral hypoglycemic agents
  • MAO Inhibitors (Effects many anesthesia drugs)
38
Q

Medications to take with a SIP of H20

  • Anti________ (2)*
  • (1) Blockers (SCIP!)
  • (1) Blockers
  • S______
  • Anti_______
  • Chronic _____ medications*
  • Drugs to treat ______* (inform anesthesia team)
A
  • Antihypertensives (ACES & ARBS)*
  • Beta Blockers (SCIP!)
  • Calcium channel blockers
  • Statins
  • Anticonvulsants
  • Chronic pain medications*
  • Drugs to treat addiction* (inform anesthesia team)
39
Q

NPO Guidelines

Usual instruction? To get a minimum of how many hours after a light meal?

  • ASA Fasting Recommendations:
    • Clear liquids =
    • Breast milk =
    • Infant formula
    • Nonhuman milk =
    • Light meal =
    • Regular meal =
A

Usual instruction- NPO after midnight, or a minimum of 6 hours after a light meal

  • ASA Fasting Recommendations:
    • Clear liquids 2h
    • Breast milk 4h
    • Infant formula
    • Nonhuman milk 6h
    • Light meal 6h
    • Regular meal 8h

Dt aspiration precautions bc when they are unconscious will lose protective reflex

40
Q

Fluid Considerations

  • Patients may be Nil Per Os (NPO) for up to __ hours before surgery
  • Inpatient = ______ containing fluids should be started when NPO to prevent (1)
  • Outpatient =
A
  • Patients may be Nil Per Os (NPO) for up to 12 hours before surgery
  • Inpatient = Dextrose containing fluids should be started when NPO to prevent lean muscle catabolism
  • Outpatient = Fluid status should be assessed and IV fluid administered accordingly
41
Q

What about piercings?

A

Have patient move all piercings, no matter how cute they look!

42
Q

ASA Physical Status Classification

List each description into ASA Classes 1-6

A patient with mild systemic disease with no functional limitations

A moribund patient who is not expected to survive without operation

A healthy patient

Brain dead whose organs are being harvested

A patient with severe systemic disease that is a constant threat to life

A patient with severe systemic disease resulting in functional limitations

A
  1. A healthy patient
  2. A patient with mild systemic disease with no functional limitations
  3. A patient with severe systemic disease resulting in functional limitations
  4. A patient with severe systemic disease that is a constant threat to life
  5. A moribund patient who is not expected to survive without operation
  6. Brain dead whose organs are being harvested
  • >65yo automatically at least a 2
  • Stage 4 = ESRD with dialysis patients
43
Q

Considerations Influencing the Choice of Anesthetic Technique

✔ Coexisting d____ that may or may not relate to the reason for surgery (GERD, asthma, recent MI)

✔ Surgical s____ being operated on

✔ P_____ of the patient during surgery

✔ A___/maturity of the patient

✔ Patient pr______

✔ Em_______ or el_____

✔ L_______ of planned surgical procedure

A

✔ Coexisting disease that may or may not relate to the reason for surgery (GERD, asthma, recent MI)

✔ Surgical site being operated on

✔ Position of the patient during surgery

✔ Age/maturity of the patient

✔ Patient preference

✔ Emergency or elective

✔ Length of planned surgical procedure

44
Q

Types of Anesthetics

  1. Minimal Sedation/Anesthesia: Appropriate response to ____l_ stimuli
  2. Moderate Sedation/Analgesia (Conscious sedation): Purposeful response to _____/_____ stimulation
  3. Deep Sedation/Analgesia (MAC): Purposeful response to re_____ or n______ stimulation
A
  1. Minimal Sedation/Anesthesia: Appropriate response to verbal stimuli
  2. Moderate Sedation/Analgesia (Conscious sedation): Purposeful response to verbal/tactile stimulation
  3. Deep Sedation/Analgesia (MAC): Purposeful response to repeated or noxious stimulation (**surgeon will likely give the local anesthesia to the site.)
45
Q

General Anesthesia Involves

  1. Complete loss of C_____ness
  2. Complete loss of S______
  3. Complete loss of P_____
  4. Complete loss of A_____ness
A
  1. Complete loss of consciousness
  2. Complete loss of sensation
  3. Complete loss of pain
  4. Complete loss of awareness
46
Q

Peripheral Nerve Blocks

Why are peripheral nerve blocks increasing in frequency?

What is one of the advances of using a peripheral nerve block?

Are there serious complications with peripheral nerve blocks?

A

Peripheral nerve blocks are increasing in frequency due to recent advances in ultrasound technology

PNB’s have may advances including decreased narcotic requirements and increased patient satisfaction

Serious complications are rare but do occur

(Choosing to perform PNB requires consideration of each patient and surgical procedure, as well as individual surgeon preferences)

47
Q

Indications for regional block

  • O_______-sparing population
  • Sleep ______ Patients
  • Ob_____
  • Co______
  • Ad_____ General Anesthesia sequelae
A
  • Opioid-sparing population
  • Sleep Apnea Patients
  • Obesity
  • Comorbidities
  • Adverse General Anesthesia sequelae
48
Q

Contraindications to Nerve Block

  • Needle ph_____ or otherwise unc_____
  • Excessive sedation (adults)
  • In______ (local and untreated systemic)
  • Antic_______?
  • Pre-existing n_____ injury?
  • Surgery specific (e.g. motor block and post-op neuro exam)
  • Block specific (e.g pulmonary disease and interscalene block)
A
  • Needle phobia or otherwise uncooperative
  • Excessive sedation (adults)
  • Infection (local and untreated systemic)
  • Anticoagulation?
  • Pre-existing nerve injury?
  • Surgery specific (e.g. motor block and post-op neuro exam)
  • Block specific (e.g pulmonary disease and interscalene block)
49
Q

Advantages of Regional Blocks

(2)

A

Avoidance of general anesthesia

Post operative pain control

50
Q

Avoidance of General Anesthesia (PNB)

  • Decreased Post op (1)
  • Decreased sore th____
  • Decreased post op de_____
  • No airway ob_____ and respiratory dep_____
  • ________ time to discharge from PACU
  • Increased patient sat_______
A
  • Decreased PONV
  • Decreased sore throat
  • Decreased post op delirium
  • No airway obstruction and respiratory depression
  • Decreased time to discharge from PACU
  • Increased patient satisfaction
51
Q

Post Operative Pain Control (PNB)

  • Decreased n______ requirements and associated adverse side effects (e.g. nausea, pruritis, sedation, confusion, respiratory depression)
  • Earlier recovery of b_____ function
  • Improved tolerance of ph_____ therapy
  • Improved p____ scores, but not always in PACU
  • Increased patient s______
A
  • Decreased narcotic requirements and associated adverse side effects (e.g. nausea, pruritis, sedation, confusion, respiratory depression)
  • Earlier recovery of bowel function
  • Improved tolerance of physical therapy
  • Improved pain scores, but not always in PACU
  • Increased patient satisfaction
52
Q

Disadvantages of PNB

Are few but include

  • Infra_______ requirements and potential for surgeon de____
  • F_____ blocks
  • Intraoperative a____ness and non-operative discomfort (e.g. po_____)
  • M____ block
  • Variable d______ (~4-40 hours)
  • Rare serious complications (e.g. local anesthetic t_____, nerve in____)
A
  • Infrastructure requirements and potential for surgeon delays
  • Failed blocks
  • Intraoperative awareness and non-operative discomfort (e.g. positioning)
  • Motor block
  • Variable duration (~4-40 hours)
  • Rare serious complications (e.g. local anesthetic toxicity, nerve injury)
53
Q

Common Peripheral Nerve Blocks

  • (1): Trigeminal, Retrobulbar
  • (1): Cervical Plexus, Laryngeal nerve block
  • (1): Brachial plexus, Interscalene, Bier Block
  • (1): Femoral, sciatic, ankle
A
  • Face: Trigeminal, Retrobulbar
  • Neck: Cervical Plexus, Laryngeal nerve block
  • Upper extremity: Brachial plexus, Interscalene, Bier Block
  • Lower Extremity: Femoral, sciatic, ankle
54
Q

Spinal Block (SAB)

Spread of local anesthetic agent into the tissues of the CNS within the CSF is determined by:

  1. D____ injected (ml administered)
  2. L_____ solubility
  3. Local bl___ flow
  4. Surface _____ exposed
A
  1. Dose injected (ml administered)
  2. Lipid solubility
  3. Local blood flow
  4. Surface area exposed
55
Q

MH is a Crisis

What is the best way to prevent MH?

A

Best prevented by healthcare providers is being educated and prepared

56
Q

A rare inherited disorder of skeletal muscle metabolism that is triggered in susceptible individuals resulting in hyperthermia, skeletal muscle damage, a hypermetabolic state, and death if not recognized or left untreated.

A

Malignant Hyperthermia

57
Q

Triggering Agents for Malignant Hyperthermia

  • (5) -flurane
  • (1) - thane
  • (1) - choline
A
  • ​​Desflurane
  • Enflurane
  • Isoflurane
  • Methoxyflurane
  • Sevoflurane
  • Halothane
  • Succinylcholine
58
Q

Physiologic Mechanism of Malignant Hyperthermia

  • A bio_______ chain reaction
  • Abnormal handling of intracellular (1) levels caused by the inability of the (1) to regulate Calcium
  • A hy____metabolic crisis is seen as manifested by respiratory and metabolic ____osis, ____cardia, cardiac ______, skeletal muscle r______, and rh________.
A
  • A biochemical chain reaction
  • Abnormal handling of intracellular Calcium levels caused by the inability of the muscles to regulate Calcium
  • A hypermetabolic crisis is seen as manifested by respiratory and metabolic acidosis, tachycardia, cardiac dysrhythmias, skeletal muscle rigidity, and rhabdomyolysis.
59
Q

Malignant Hyperthermia Pathophysiology

  1. Triggering agent binds to (1) R_____ receptor
  2. Ca channel stays _____ resulting in high Ca levels
  3. High levels of Ca causes muscles to ______
  4. The ______metabolic state sets up a dangerous positive-feedback cycle
A
  1. Triggering agent binds to (Ca Gatekeeper) Ryanodine receptor
  2. Ca channel stays open resultting in high Ca levels
  3. High levels of Ca causes muscles to contract
  4. The hypermetabolic state sets up a dangerous positive-feedback cycle
60
Q

Clinical Manifestations of Malignant Hyperthermia

Resulting from the increased myoplasmic calcium concentration.

*First Sign* =

A

**Masseter Muscle Spasm…Generalized Muscle Rigidity***

61
Q

Hypermetabolism Results in MH

  • _____capnia
  • ____xemia
  • _____cardia
  • ____osis (Respiratory/Metabolic)
  • _____ PRODUCTION: Elevated T____ (late sign) late sign is like 3min, can get as high as 110F
A
  • Hypercapnia
  • Hypoxemia
  • Tachycardia
  • Acidosis (Respiratory/Metabolic)
  • HEAT PRODUCTION: Elevated TEMP (late sign) late sign is like 3min, can get as high as 110F
62
Q

Resulting from rhabdomyolysis

  • Increased C__ and __ concentrations
  • Cardiac (1)
  • (1) uria
  • Renal _____
A
  • Increased CK and K concentrations
  • Cardiac arrhythmias
  • Myoglobinuria
  • Renal failure
63
Q

Genetics and MH

Over __ genetic defects have been associated with MH

MH Susceptible Individuals

  • CCD (1) and MmD (1)
  • BMD (1)
  • Myo____
  • DMD (1)
A

Over 80 genetic defects have been associated with MH

  • Those who carry the gene may be completely unaware of the risk unless they have a family member or they themselves have developed an MH reaction.

(50%/50% from parents, 25% chance to children)

MH Susceptible Individuals

  • CCD (Central Core Disease) and MmD (Multiminicore Disease)
  • Becker’s Muscular Dystrophy (BMD)
  • Myotonias
  • Duchenne’s Muscular Dystrophy (DMD)
64
Q

Incidence of MH

1 in 10,000 ______ , 1 in 50,000 _____

High incidence areas in the United States include:

  • W_____
  • N______
  • West V____
  • M_____

** (1) Population has a high incidence of MH.***

A

1 in 10,000 Children, 1 in 50,000 Adults

High incidence areas in the United States include:

  • Wisconsin
  • Nebraska
  • West Virginia
  • Michigan

** Swedish Population has a high incidence of MH.***

65
Q

Current treatment of MH

(2)

A

Dantrolene*

Ryandex*

66
Q

Dantrolene

MOA

Dose

With every ___ minutes of delay between crisis recognition and administration of dantrolene sodium, there is a ___% increase in complications, including death

A

Works on the ryanodine receptor preventing the release of calcium

2.5mg/kd in sterile distilled water q5 min until symptoms resolve

  • Eg. 85kg * 2.5mg= 212mgs
  • Each vial contains only 20mg
  • Dissolve 20mg bottle in 60 ml of sterile preservative free water

With every 20 minutes of delay between crisis recognition and administration of dantrolene sodium, there is a 30% increase in complications, including death

67
Q

Ryanodex

Indicated for tx of MH in conjunction with appropriate supportive measures and for prevention of MH patients at high risk

How to reconstitute?

A
  • Use 5ml of sterile water to reconstitute a vial
  • Should take less than 10 seconds
  • In most cases, 1 vial is required to meet the patients loading dose and can be prepared and administered in 1 minute
68
Q

Ryanodex Treatment Dose

For pediatric and adult patients, administered via (1) route at a minimum dose of ___mg/kg. If the physiologic and metabolic abnormalities of MH continue, administer additional IV boluses up to a maximum cumulative dose of __mg/kg

A

For pediatric and adult patients, administered via IVP route at a minimum dose of 1mg/kg. If the physiologic and metabolic abnormalities of MH continue, administer additional IV boluses up to a maximum cumulative dose of 10mg/kg

69
Q

Ryanodex Prophylactic Dose

____mg/kg IV over __ minute __ minutes prior to surgery

A

2.5mg/kg IV over 1 minute 75 minutes prior to surgery

70
Q

Diagnostic Tests for MH

(2)

A
  1. Genetic Testing (Ryanodine Receptor RYR1 gene sequencing)
  2. Caffeine-Halothane contracture test (CHCT)
71
Q

Genetic Testing (Ryanodine Receptor RYR1 gene sequencing)

Presence of causative mutation in (1) gene is diagnostic for MH susceptibility

Do all patients who get MH have this gene?

What is the sensitivity of this genetic test?

A

Presence of causative mutation in RYR1 gene is diagnostic for MH susceptibility

Not all proven MHS individuals have been found to harbor a causative mutation.

Sensitivity of the genetic test depends upon factors including the population selected and the methodology of the test.

72
Q

Gold Standard for MH Diagnosis

=

A

Caffeine-Halothane contracture test (CHCT) muscle contracture test

73
Q

Muscle Contracture Test

How is the test done?

What is the sensitivity?

A

Biopsy of skeletal muscle is sampled from the thigh to assess muscle contracting properties when exposed to ryanodine receptor agonist (eg. caffeine, halothane)

Abnormally high levels of contractile force indicated MH susceptibility

Close to 100% sensitivity (false negatives are rare)

74
Q

MH Treatment Protocol

  1. ______ triggering agent. CALL FOR ____.
  2. (1) with high flow ___% O2
  3. Administer (1) 1-2 meq/kg IV
  4. Mix (1) with 60ml sterile distilled water at ___mg/kg IV STAT
  5. Apply (1) (blanket, lavage, cool irrigations, IV fluids)
  6. Administer (1) doses of dantrolene- up to __mg/kg
  7. Treat hyper____/ ventricular _____
  8. Consider invasive m______
  9. Contact (1) at 1-800-644-9737
A
  1. Discontinue triggering agent. CALL FOR HELP.
  2. Hyperventilate with high flow 100% O2
  3. Administer NaHCO3 1-2 meq/kg IV
  4. Mix dantrolene sodium with 60ml sterile distilled water at 2.5mg/kg IV STAT
  5. Apply cooling measures (blanket, lavage, cool irrigations, IV fluids)
  6. Administer additional doses of dantrolene- up to 10mg/kg
  7. Treat hyperkalemia/ ventricular dysrhythmias
  8. Consider invasive monitoring
  9. Contact MHAUS at 1-800-644-9737
75
Q

Post Crisis Intervention

  1. Administer dantrolene __mg/kg every _-_ hours for __-__ hours or a continuous infusion of ____mg/kg/hr for the next __ hours
  2. Monitor for (1) for 24 hours- rate is __%
  3. Monitor el_____, blood g___, C__, core t_____, _____ output and color, co_____ studies
  4. Monitor for signs of (1)
A
  1. Administer dantrolene 1mg/kg every 4-6 hours for 24-48 hours or a continuous infusion of 0.25mg/kg/hr for the next 24 hours
  2. Monitor for reoccurrence for 24 hours- rate is 25%
  3. Monitor electrolytes, blood gases, CK, core temperature, urine output and color, coagulation studies
  4. Monitor for signs of rhabdo

Diagnosis and Management (36 decks)

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