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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
Q

Most important risk factor for post op apnea in ex preterm

A

Postmenstrual age
PMA

next is GA

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26
Q

ex preterm without risk factor will decrease post op apnea after

A

43 weeks PmA

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27
Q

pre op eval of ex preterm

A

thorough pre op hx
apnea at home
anemia

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28
Q

in preterm
delay elective procedure until

A

60 weeks PMA

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29
Q

preterm
admit to icu if apnea within

A

12 hrs

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30
Q

differentiate pathologic vc innocent murmur

A
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31
Q

detailed cardiac evaluation

A
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32
Q

Major risk factors for increased mortality in cardiac px

A

cyanosis
younger age
complex cardiac defects
poor general health
current tx for cardiac failure

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33
Q

Risk strat for specific cardiac lesion

A
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34
Q

Risk strat of children with heart disease undergoing non cardiac surgery

A
35
Q

in neuromuscular d/o
what to request

A

creatinine kinase
myoglobin
abg
ecg
chest xray
pft

36
Q

anesthetics preferred in

A

total iv anesthetics

(inhalation causes rhabdomyolysis and hyperkalemia)

37
Q

meds that can decrease protective reflexes

A
38
Q

increased risk of volume regurg
pre emptive ngt

A

gerd
esophageal dys motility
difficult swallowing
diabetes
gas bloat
obstructing cancer

39
Q

pre op fasting

light meal or non human milk

A

6 hours

40
Q

fasting
clear liquids

A

2 hours

41
Q

breastmilk
fasting

A

atleast 4 hours

42
Q

formula milk fasting

A

6 hrs

43
Q

majority of events occurred like aspiration

A

during induction of anesthesia

44
Q

longer wake up time
combined iv and inhaled anesthesia

A

autism spectrum

45
Q

If with URTI, delay elective surgery

A

2 to 3 weeks after resolution of URTI symptoms

46
Q

recent urti is less than ___ weeks of respi events (hypoxemia, bronchospasm, laryngospasm)

A

2 weeks

47
Q

algorithm in child with urti for surgery

A
48
Q

child with urti
surgery not urgent
infectious etiology
with severe respi sx.

A

postpone for 4 weeks

49
Q

preop screening tool predicting perioperative respi events
for less than 6 yo

predicting cancellations (if 19 higher)

A

COLDS scoring

C current sx
O onset
L lung disease
D device to be used for airway management

Surgery type

50
Q

Perioperative management of children with URTI

salbutamol
cut off is 20 kg for dose

A

salbutamol 2.5 mg if less than 20 kg
5 mg (2 neb) if more than 20 kg

51
Q

to suppress airway reflexes

A

Lidocaine IV
1.5 mg/kg

52
Q

Good airway reflux blunting
mild bronchodilator effects

A

Propofol

53
Q

extubation

A

awake extubation
immediate o2 supplementation
cpap

54
Q

post op

A

o2 supplementation via nasal prong
adequate hydration and analgesia

55
Q

good bronchodilator
but limited effects in suppressing reflexes

A

volatile anaesthetic agents
sevoflurane, halothane

in high risk, iv propofol over inhalation

56
Q

asthma exacerbation, delay elective surgery for

A

4-6 weeks after exacerbation (2-3 weeks for URTI)

57
Q

well controlled asthma

A

inhaled saba
1-2 hrs before

58
Q

partly controlled

A

ONE WEEK before
inhaled saba plus inhaled corticosteroids

59
Q

POORLY CONTROLLED.

A

SYSTEMIC steroids
3-5 days before

60
Q

asthmatic
on long term HIGH dose ICS
received systemic steroids for 2 wks for the previous 6 months

A

hydrocortisone periop

61
Q

for px with long standing asthma

A

pre op pft

62
Q

mainstay for px with status asthmaticus

A

inhaled saba

continuous nebulization

63
Q

pre op planning in children with asthma

A
64
Q

Osa not an absolute requirement but may be requested in

A

less than 2 yo
with comorbidities
discordant hx and pe

surgical planning in severe OSA

65
Q

OSA recommendation

A

NSaids for post op management

cpap/bipap resume post op

66
Q

post op complication of osa

A

pulmo edema
laryngospasm / bronchospasm
post op apnea/hypopnea
hypercarbia
respi failure

67
Q

Other risk factors post op complications after tonsillectomy in osa px

A

Less than 3 yo
Severe osa AHI >10 in AAP

68
Q

Criteria for determination of surgical location and post op osa

A
69
Q

Osa px has increased sensitivity. to

A

opioids

dose reduce by 50%

70
Q

decreases post op requirement for opioids and other analgesics

A

dexamethasone

71
Q

post op surveillance

A

extended monitoring

rr
pulse ox

transthoracic impedance
nasal capnography
transcutaneous co2
acoustic monitoring

72
Q

preop guidelines during covid 19

A
73
Q

preop guidelines during covid 19

A
74
Q

Rt pcr

A

48 hrs prior the procedure

75
Q

xray scan

A

not recommended

76
Q

if px travelled to a country/locality with sustained transmission

A

delay for 14 days even asymptomatic

77
Q

direct contact confirmed covid 19

A

delay 14 days from last contact
even asymptomatic

78
Q

if symptomatic
unexplained cough

A

decer

79
Q

had covid 19 infection

asymptomatic px
mile non respi sx

A

4 weeks interval

80
Q

had covid 19
symptomatic
OPD basis

A

6 weeks

81
Q

had covid 19
diabetic
hospitalized
immunocompromised

A

8-10 weeks

82
Q

had covid
icu

A

12 weeks

83
Q

pediatric pre ip questionnair

A
84
Q

pre op quest part 2

A

PAPP Guidelines (2 decks)

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