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PAPP Guidelines > Pre op > Flashcards

Pre op Flashcards

1
Q

how long should you re schedule elective surgery after exacerbation

A

1 month after

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2
Q

Who should receive corticosteroids peripoperatively because of risk of adrenal crisis

A

patient on OCS for 2 weeks for the last 6 months

on long term use high dose ICS

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3
Q

Modified mallampati classification

A

amount of
mouth opening
to the size of the tongue

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4
Q

STBUR questionnaire for OSA

A

3 or 5 out of 5

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5
Q

Risk quartile category for pediatric surgical procedure

A

R1 and R2 Low risk
R3 and R4 High risk

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6
Q

5 family hx needs to be asked

A

malignant hyperthermia

pOst op nausea and vomiting

bleeding

pseudocholinesterase deficiency

muscular dystrophy

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7
Q

most common finding in children with difficult airways

A

micrognathia

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8
Q

one of the major cause of anesth related cardiac arrest

A

difficult airway

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9
Q

difficult airway mnemonic

A
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10
Q

initial predictors of post op outcomes

A

FEV1
DLCO

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11
Q

ECG may be considered

A

Scoliosis
Severe OSA
BPD
CHD
murmur or arrythmia

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12
Q

Validity of normal lab results for pre op

A

4 months

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13
Q

nutritional therapy prior elective major surgery for patients with severe nutritional risk

A

7-14 days

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14
Q

limit fasting to

A

3 hours

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15
Q

epileptic seizures may happen how many hrs after surgery

A

72 hours

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16
Q

Pedia risk strat tools

A

ASA PD - to communicate px medical comorbidities

NARCO-SS for adverse effects and escalation of care

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17
Q

continuation of asa ps

A
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18
Q

NARCO-SS

A

Neuro
Airway
Respi
Cardiac
O

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19
Q

Pedia Surgical Risk Classification based in risk strat tools

A
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20
Q

refer to specialist for sedation if

A

neonates less than 1 month
ex premature less than 60 weeks pca

airway abnormalities
OsA
neurologic impairement
inc icp
severe obesity

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21
Q

full term
___ pca may undergo sedation outside OR with low risk

A

more than 45 weeks pca

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22
Q

previous preterm with PCA less than 46 weeks should be admitted and monitored for atleast 12 hours post op

A
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23
Q

children 3 yo
Severe OSA

AHI more than 10 per hour
o2 sat <80%

A

admitted for overnight monitoring

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24
Q

OSA HIGH RISK if with

A

RVH
Craniofacial
neuromuscular
CP
Down
FTT
morbid ebesity
premature
sickle cells
Central hypoventilation
metabolic dx
CLD

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25
Most important risk factor for post op apnea in ex preterm
Postmenstrual age PMA next is GA
26
ex preterm without risk factor will decrease post op apnea after
43 weeks PmA
27
pre op eval of ex preterm
thorough pre op hx apnea at home anemia
28
in preterm delay elective procedure until
60 weeks PMA
29
preterm admit to icu if apnea within
12 hrs
30
differentiate pathologic vc innocent murmur
31
detailed cardiac evaluation
32
Major risk factors for increased mortality in cardiac px
cyanosis younger age complex cardiac defects poor general health current tx for cardiac failure
33
Risk strat for specific cardiac lesion
34
Risk strat of children with heart disease undergoing non cardiac surgery
35
in neuromuscular d/o what to request
creatinine kinase myoglobin abg ecg chest xray pft
36
anesthetics preferred in
total iv anesthetics (inhalation causes rhabdomyolysis and hyperkalemia)
37
meds that can decrease protective reflexes
38
increased risk of volume regurg pre emptive ngt
gerd esophageal dys motility difficult swallowing diabetes gas bloat obstructing cancer
39
pre op fasting light meal or non human milk
6 hours
40
fasting clear liquids
2 hours
41
breastmilk fasting
atleast 4 hours
42
formula milk fasting
6 hrs
43
majority of events occurred like aspiration
during induction of anesthesia
44
longer wake up time combined iv and inhaled anesthesia
autism spectrum
45
If with URTI, delay elective surgery
2 to 3 weeks after resolution of URTI symptoms
46
recent urti is less than ___ weeks of respi events (hypoxemia, bronchospasm, laryngospasm)
2 weeks
47
algorithm in child with urti for surgery
48
child with urti surgery not urgent infectious etiology with severe respi sx.
postpone for 4 weeks
49
preop screening tool predicting perioperative respi events for less than 6 yo predicting cancellations (if 19 higher)
COLDS scoring C current sx O onset L lung disease D device to be used for airway management Surgery type
50
Perioperative management of children with URTI salbutamol cut off is 20 kg for dose
salbutamol 2.5 mg if less than 20 kg 5 mg (2 neb) if more than 20 kg
51
to suppress airway reflexes
Lidocaine IV 1.5 mg/kg
52
Good airway reflux blunting mild bronchodilator effects
Propofol
53
extubation
awake extubation immediate o2 supplementation cpap
54
post op
o2 supplementation via nasal prong adequate hydration and analgesia
55
good bronchodilator but limited effects in suppressing reflexes
volatile anaesthetic agents sevoflurane, halothane in high risk, iv propofol over inhalation
56
asthma exacerbation, delay elective surgery for
4-6 weeks after exacerbation (2-3 weeks for URTI)
57
well controlled asthma
inhaled saba 1-2 hrs before
58
partly controlled
ONE WEEK before inhaled saba plus inhaled corticosteroids
59
POORLY CONTROLLED.
SYSTEMIC steroids 3-5 days before
60
asthmatic on long term HIGH dose ICS received systemic steroids for 2 wks for the previous 6 months
hydrocortisone periop
61
for px with long standing asthma
pre op pft
62
mainstay for px with status asthmaticus
inhaled saba continuous nebulization
63
pre op planning in children with asthma
64
Osa not an absolute requirement but may be requested in
less than 2 yo with comorbidities discordant hx and pe surgical planning in severe OSA
65
OSA recommendation
NSaids for post op management cpap/bipap resume post op
66
post op complication of osa
pulmo edema laryngospasm / bronchospasm post op apnea/hypopnea hypercarbia respi failure
67
Other risk factors post op complications after tonsillectomy in osa px
Less than 3 yo Severe osa AHI >10 in AAP
68
Criteria for determination of surgical location and post op osa
69
Osa px has increased sensitivity. to
opioids dose reduce by 50%
70
decreases post op requirement for opioids and other analgesics
dexamethasone
71
post op surveillance
extended monitoring rr pulse ox transthoracic impedance nasal capnography transcutaneous co2 acoustic monitoring
72
preop guidelines during covid 19
73
preop guidelines during covid 19
74
Rt pcr
48 hrs prior the procedure
75
xray scan
not recommended
76
if px travelled to a country/locality with sustained transmission
delay for 14 days even asymptomatic
77
direct contact confirmed covid 19
delay 14 days from last contact even asymptomatic
78
if symptomatic unexplained cough
decer
79
had covid 19 infection asymptomatic px mile non respi sx
4 weeks interval
80
had covid 19 symptomatic OPD basis
6 weeks
81
had covid 19 diabetic hospitalized immunocompromised
8-10 weeks
82
had covid icu
12 weeks
83
pediatric pre ip questionnair
84
pre op quest part 2

PAPP Guidelines (2 decks)

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