Pre-Op Flashcards
What is the Mallampati score? What are the four classes?
Ability to view the pt’s oropharyngeal structures with the pt in an upright position, their mouth open as wide as possible without sticking out their tongue.
Class I: Tonsillar pillars, soft palate, entire uvula
Class II: Pillars and soft palate, only part of uvula
Class III: Soft palate and base of uvula; possibly difficult intub.
Class IV: Hard palate only; difficult/impossible intub.
What are the minimum fasting guidelines for:
- Solid food, milk, instant formula
- Breast milk
- Clear liquids (water, juices, soda, black coffee)
- Solid food, milk, instant formula: 6 hours
- Breast milk: 4 hours
- Clear liquids (water, juices, soda, black coffee): 2 hours
What preoperative labs are done?
No test is absolutely required for anesthesia, especially for healthy pts
- Consider pregnancy testing if possibility of pregnancy
- Consider creatinine if contrast would be used
- Order H+H, type and screen if significant blood loss anticipated
What preoperative labs are done for pt’s with the following:
- Diabetes, renal disorders, endocrine disorders
- Cardiovascular disease
- Severe obesity
For any of these comorbidities, get electrolytes, creatinine and glucose.
What preoperative tests are done for pt’s with the following:
- Significant liver disease
- Hematologic disorders, malignancy
For any of these comorbidities, get CBC, platelets, and PT/PTT.
When is EKG done preoperatively?
- Symptoms or findings such as chest pain, syncope, palpitations, dyspnea, irregular pulse, murmur, peripheral edema, rales, suspected or recent MI/unstable angina
- Risk modification/stratification for pts undergoing vascular surgery, pts with at least one clinical risk factor (CAD, CVD, PVD, diabetes, Cr>2) undergoing intermediate or high-risk surgery
When is antibiotic prophylaxis used to prevent IE?
Prophylaxis is used for pts with:
- Prosthetic cardiac valve or previous IE
- Congenital heart disease
- Repaired CHD with residual defect at the site
- Previous cardiac transplantation with subsequent cardiac valvulopathy
What is the recommended antibiotic regimen (oral, IV)? What is used for penicillin-allergic patients?
Antibiotics are given 30-60 min before surgery.
- Oral: amoxicillin 2 g or cephalexin 2 g; for PCN-allergic pts, use clindamycin 600 mg, azithromycin 500 mg, clarithromycin 500 mg
- IV: cefazolin 2 g or ceftriaxone 1g; for PCN-allergic pts, use clindamycin 600 mg
What is the protocol for patients already taking:
- B-blockers
- Statins
- Antiplatelet (plavix or ASA)
- Xarelto
- B-blockers: continue therapy
- Statins: continue therapy
- Antiplatelet: stop 7 days before
- Xarelto: stop 48 hours before
Which conditions may require delay of surgery for optimization?
- Recent MI, unstable cardiac rhythm, uncontrolled or malignant HTN
- Coagulopathy
- Hypoxia or respiratory insufficiency
- Untreated hyperthyroidism
What are the seven ASA physical status classifications? Give an example of each
I. No organic, physiologic, or psychiatric problems; e.g. healthy pt
II. Controlled medical conditions with mild systemic effects and no limitations in functional ability; e.g. controlled HTN, smoker, obesity
III. Medical conditions with severe systemic effects and limitations in functional ability; e.g. controlled CHF, stable angina, morbid obesity, COPD, chronic renal insufficiency
IV. Poorly controlled medical conditions associated with significant impairment in functional ability that is a potential threat to life; e.g. unstable angina, symptomatic COPD or CHF
V. Critical condition, little chance of survival without surgery; e.g. ruptured AAA
VI. Brain dead, undergoing organ donation
E. Emergency, trauma; e.g. gunshot would, GI perforation
