Pre op Flashcards
how long should you re schedule elective surgery after exacerbation
1 month after
Who should receive corticosteroids peripoperatively because of risk of adrenal crisis
patient on OCS for 2 weeks for the last 6 months
on long term use high dose ICS
Modified mallampati classification
amount of
mouth opening
to the size of the tongue
STBUR questionnaire for OSA
3 or 5 out of 5
Risk quartile category for pediatric surgical procedure
R1 and R2 Low risk
R3 and R4 High risk
5 family hx needs to be asked
malignant hyperthermia
pOst op nausea and vomiting
bleeding
pseudocholinesterase deficiency
muscular dystrophy
most common finding in children with difficult airways
micrognathia
one of the major cause of anesth related cardiac arrest
difficult airway
difficult airway mnemonic
initial predictors of post op outcomes
FEV1
DLCO
ECG may be considered
Scoliosis
Severe OSA
BPD
CHD
murmur or arrythmia
Validity of normal lab results for pre op
4 months
nutritional therapy prior elective major surgery for patients with severe nutritional risk
7-14 days
limit fasting to
3 hours
epileptic seizures may happen how many hrs after surgery
72 hours
Pedia risk strat tools
ASA PD - to communicate px medical comorbidities
NARCO-SS for adverse effects and escalation of care
continuation of asa ps
NARCO-SS
Neuro
Airway
Respi
Cardiac
O
Pedia Surgical Risk Classification based in risk strat tools
refer to specialist for sedation if
neonates less than 1 month
ex premature less than 60 weeks pca
airway abnormalities
OsA
neurologic impairement
inc icp
severe obesity
full term
___ pca may undergo sedation outside OR with low risk
more than 45 weeks pca
previous preterm with PCA less than 46 weeks should be admitted and monitored for atleast 12 hours post op
children 3 yo
Severe OSA
AHI more than 10 per hour
o2 sat <80%
admitted for overnight monitoring
OSA HIGH RISK if with
RVH
Craniofacial
neuromuscular
CP
Down
FTT
morbid ebesity
premature
sickle cells
Central hypoventilation
metabolic dx
CLD
Most important risk factor for post op apnea in ex preterm
Postmenstrual age
PMA
next is GA
ex preterm without risk factor will decrease post op apnea after
43 weeks PmA
pre op eval of ex preterm
thorough pre op hx
apnea at home
anemia
in preterm
delay elective procedure until
60 weeks PMA
preterm
admit to icu if apnea within
12 hrs
differentiate pathologic vc innocent murmur
detailed cardiac evaluation
Major risk factors for increased mortality in cardiac px
cyanosis
younger age
complex cardiac defects
poor general health
current tx for cardiac failure
Risk strat for specific cardiac lesion
Risk strat of children with heart disease undergoing non cardiac surgery
in neuromuscular d/o
what to request
creatinine kinase
myoglobin
abg
ecg
chest xray
pft
anesthetics preferred in
total iv anesthetics
(inhalation causes rhabdomyolysis and hyperkalemia)
meds that can decrease protective reflexes
increased risk of volume regurg
pre emptive ngt
gerd
esophageal dys motility
difficult swallowing
diabetes
gas bloat
obstructing cancer
pre op fasting
light meal or non human milk
6 hours
fasting
clear liquids
2 hours
breastmilk
fasting
atleast 4 hours
formula milk fasting
6 hrs
majority of events occurred like aspiration
during induction of anesthesia
longer wake up time
combined iv and inhaled anesthesia
autism spectrum
If with URTI, delay elective surgery
2 to 3 weeks after resolution of URTI symptoms
recent urti is less than ___ weeks of respi events (hypoxemia, bronchospasm, laryngospasm)
2 weeks
algorithm in child with urti for surgery
child with urti
surgery not urgent
infectious etiology
with severe respi sx.
postpone for 4 weeks
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
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
to suppress airway reflexes
Lidocaine IV
1.5 mg/kg
Good airway reflux blunting
mild bronchodilator effects
Propofol
extubation
awake extubation
immediate o2 supplementation
cpap
post op
o2 supplementation via nasal prong
adequate hydration and analgesia
good bronchodilator
but limited effects in suppressing reflexes
volatile anaesthetic agents
sevoflurane, halothane
in high risk, iv propofol over inhalation
asthma exacerbation, delay elective surgery for
4-6 weeks after exacerbation (2-3 weeks for URTI)
well controlled asthma
inhaled saba
1-2 hrs before
partly controlled
ONE WEEK before
inhaled saba plus inhaled corticosteroids
POORLY CONTROLLED.
SYSTEMIC steroids
3-5 days before
asthmatic
on long term HIGH dose ICS
received systemic steroids for 2 wks for the previous 6 months
hydrocortisone periop
for px with long standing asthma
pre op pft
mainstay for px with status asthmaticus
inhaled saba
continuous nebulization
pre op planning in children with asthma
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
OSA recommendation
NSaids for post op management
cpap/bipap resume post op
post op complication of osa
pulmo edema
laryngospasm / bronchospasm
post op apnea/hypopnea
hypercarbia
respi failure
Other risk factors post op complications after tonsillectomy in osa px
Less than 3 yo
Severe osa AHI >10 in AAP
Criteria for determination of surgical location and post op osa
Osa px has increased sensitivity. to
opioids
dose reduce by 50%
decreases post op requirement for opioids and other analgesics
dexamethasone
post op surveillance
extended monitoring
rr
pulse ox
transthoracic impedance
nasal capnography
transcutaneous co2
acoustic monitoring
preop guidelines during covid 19
preop guidelines during covid 19
Rt pcr
48 hrs prior the procedure
xray scan
not recommended
if px travelled to a country/locality with sustained transmission
delay for 14 days even asymptomatic
direct contact confirmed covid 19
delay 14 days from last contact
even asymptomatic
if symptomatic
unexplained cough
decer
had covid 19 infection
asymptomatic px
mile non respi sx
4 weeks interval
had covid 19
symptomatic
OPD basis
6 weeks
had covid 19
diabetic
hospitalized
immunocompromised
8-10 weeks
had covid
icu
12 weeks
pediatric pre ip questionnair
pre op quest part 2
