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Assessment Exam 1 > Pre-Op Assessment > Flashcards

Pre-Op Assessment Flashcards

1
Q

Why do we do a pre-operative evaluation?

A

Assessment of peri-op risk, clinical optimization, and plan post op pain management

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2
Q

Metric BMI formula

A

Weight in kg / (Height in cm squared x 10,000)

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3
Q

Imperial BMI formula

A

703 x Weight in lbs / Height in inches squared

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4
Q

Underweight BMI

A

Less than 18.5

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5
Q

Overweight BMI

A

Greater than 25-29.9

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6
Q

Obese BMI

A

Greater than 30

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7
Q

Focused physical exam contains which components?

A

Neuro, CV, Pulm, airway, endocrine, liver/renal, immunocompromised, and obesity

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8
Q

Components of an emergent physical exam?

A

AMPLE: Allergies, Medications, PMH, Last meal, Events leading up to surgery

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9
Q

Components of an airway exam?

A

Mallampati, Interincisors gap, thyromental distance, forward movement of the mandible, range of cervical spine motion. Documentation of any loose or chipped teeth. Assess for tracheal deviation

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10
Q

What should we worry about with patients with recent coronary stents?

A

Reocclusion if in the past 90 days

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11
Q

If a patient has PAD, we also worry about

A

Bad carotids and coronaries

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12
Q

G6PD deficiency

A

Factor V decreases; Common in pregnant women

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13
Q

What do we worry about with RA?

A

Joint instability

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14
Q

What do we worry about with ankylosing spondylitis

A

Neuromuscular deficits

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15
Q

Which court case helped establish what the practice of informed consent?

A

Salgo v. Leland Stanford Jr. University Board of Trustees

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16
Q

Define frailty

A

State of increased vulnerability to physiologic stress

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17
Q

High (>5%) risk surgical procedures

A

Aortic and vasculature procedures

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18
Q

Intermediate (1-5%) risk surgical procedures

A

Abdominal, thoracic, endarts, head/neck surgeries

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19
Q

Low (<1%) risk surgical procedures

A

Ambulatory, breast, endo, catatract, skin, urologic, ortho

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20
Q

Revised cardiac risk index

A

1 point for every yes; High risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular), ischemic heart disease, history of CHF, history of cerebrovascular, DM, and creat > 2.0

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21
Q

What is the purpose of the RCRI?

A

Estimates risk of cardiac complications after surgery

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22
Q

Functional capacity is an assessment of

A

Cardiopulmonary fitness

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23
Q

METs cutoff

A

Less than 4

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24
Q

Poor functional capacity is indicative of

A

Increased perioperative risk

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25
Q

What does METs stand for

A

Metabolic Equivalent of Task

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26
Q

1 MET is equivalent to

A

3.5 mL/kg/min

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27
Q

1 MET

A

Eating, working at a computer

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28
Q

2 METs

A

Walking downstairs or cooking

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29
Q

3 METs

A

Walking 1 or 2 blocks on level ground

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30
Q

4 METs

A

Raking leaves, gardening

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31
Q

3 urgencies of surgery

A

Emergency, urgent, time-sensitive

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32
Q

Emergency surgery should be performed

A

When life or limb is threatened if surgery did not proceed within 6 hours or less; focus on surveillance

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33
Q

Urgent surgery

A

Life or limb would be threatened if surgery did not proceed within 6-24 hours

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34
Q

Time-sensitive surgery

A

1 to 6 weeks would adversely affect patient outcomes

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35
Q

Preoperative cardiac risk assessment algorithm

A

Step1 emergency surgery
Step 2 Active cardiac conditions: ACS, decompensated HF, significant arrhythmia, severe valvular disease
Step 3 Estimate risk of periop death or MI; review RCRI
Step 4 Assess functional capacity
Step 5: Assess whether further testing will impact care
Step 6: Proceed to surgery or consider alternative strategies

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36
Q

“Other” components of operative risk

A

Skill of surgeon, planned surgical procedure, attention to postoperative care (ICU bed availability), experience of the anesthetist

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37
Q

ASA I

A

Healthy, non smoking, no or minimal alcohol use

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38
Q

ASA II

A

A patient with mild systemic disease; Mild diseases only, without substantive limitations.

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39
Q

ASA III

A

A patient with severe systemic disease; Substantive functional limitations.

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40
Q

ASA IV

A

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

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41
Q

ASA V

A

A moribund patient patient who is not expected to survive without the operation

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42
Q

ASA VI

A

A declared brain-dead patient whose organs are being removed for organ donor purposes

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43
Q

A patient classified as an ASA III might have which conditions?

A

Poorly controlled DM, HTN, or COPD. Morbid obesity, active hepatitis, ETOH dependence or abuse, PM, mod reduction of EF, ESRD undergoing dialysis, history of MI, CVA, TIA, or CAD/stents. Premies <60 weeks

44
Q

A patient classified as ASA IV might have which conditions?

A

Recent (less than 3 months) CVA, MI, TIA, CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, a severe reduction in EF (less than 40), sepsis, DIC, ARDs, or ESRD not going to dialysis.

45
Q

Who should get a pre operative CBC/H&H?

A

ASA 3 or 4 undergoing a moderate risk procedure or all patients undergoing a major surgery

46
Q

Who should get pre op renal panels?

A

ASA 3 or 4 undergoing moderate risk procedures. ASA 2, 3, 4 undergoing major procedures. DM, HTN, cardiac disease, dehydration, renal disease, fluid overload

47
Q

What is the focus of a renal panel for anesthetic purposes?

A

BUN and creatinine

48
Q

What values does an iStat show us?

A

Na, K, Cl, CO2, BUN, creat, BG

49
Q

Always get a chem panel after?

A

Dialysis

50
Q

Who should get pre op coagulation studies?

A

ASA 3 and 4; known or suspected coagulopathy, known bleeding disorders, liver disease, and anticoagulant use

51
Q

Who should get a pre op serum glucose and/or HbA1C?

A

Diabetics, obesity, cerebrovascular or intracranial disease, or steroids history

52
Q

Which procedure would we cancel if the patient had a UTI?

A

Ortho procedures

53
Q

What should we avoid in pregnant women (early) as to not cause teratogenicity?

A

Benzo’s and NO

54
Q

What might cause a wide mediastinum?

A

Aortic rupture, tamponade, ruptured esophagus

55
Q

General anesthesia per PP

A

Total loss of consciousness and airway control

56
Q

Name the most common allergies in order from most allergies to least

A

NMDB (Roc #1), latex, CHG, abx, opioids

57
Q

Which disease process should we expect a latex allergy in?

A

Spina Bifida

58
Q

Which foods have cross-reactivity with latex?

A

Kiwi, mango, banana, avocado, passion fruit, chestnuts

59
Q

Amide LAs

A

Have two Is (lidocaine)

60
Q

Ester LAs

A

Have one i (procaine)

61
Q

Ester reactions in some LAs are due to

A

PABA (para-aminobenzoic acid)

62
Q

What causes the allergy in NMDBs

A

The quaternary ammonium compounds

63
Q

What medications do we tell patients to continue before surgery?

A

Anti HTN (except ACE and ARB), cardiac medications such as BBs and dig, psych meds, thyroids, oral contraceptives (may dc 4 weeks prior if high DVT risk), eye drops, GERD, opioids, anticonvulsants, asthma, corticosteroids, statins, ASA (signif. cardiac disease), COX2 inhibitors (unless worried about bone healing), MAOIs (no demerol and ephedrine)

64
Q

What medications do we ask patients to stop before surgery?

A

P2Y12 inhibitors (clopedigril, ticagrelor, prasugrel), diuretics, sildenafil (unless it’s for pulm HTN), NSAIDs, coumadin, HRT, non insulin diabetics, SGLT2 inhibitors

65
Q

When should you stop clopedigril and ticagrelor?

A

7-10 days pre op

66
Q

When should you stop prasugrel?

A

10 days pre op

67
Q

When should you stop diuretics?

A

The day of - keep taking HCTZ

68
Q

When should you stop sildenafil?

A

24 hours pre op

69
Q

When should you stop taking NSAIDs?

A

48 hours

70
Q

When should you stop coumadin?

A

5 days pre op

71
Q

When should you stop HRT?

A

4 weeks pre op

72
Q

When should you stop non insulin anti diabetics?

A

Day of

73
Q

When should you stop SGLT2 inhibitors?

A

24 hours pre op

74
Q

What does of long acting insuling should type I diabetics take on the day of surgery?

A

1/3

75
Q

What dose of long acting/combo insulin should type II diabetics take on the day of surgery?

A

None or 1/2

76
Q

Why do we worry about patients on long term steroid therapy?

A

They may not release cortisone in response to stress - adrenal glands don’t work as well

77
Q

If the patient is on low dose, short duration steroids we usually give them

A

4-8 mg decadron

78
Q

Stress dose steroids are typically

A

100 mg HCZ q8 for 24 to 48 hours

79
Q

HPA suppression common with what steroid regimen?

A

> 20 mg steroid/day for at least 3 weeks

80
Q

Minor procedure periop steroid dosing

A

50 mg before cut, 25 mg q8 for 24 hours

81
Q

Minor procedure target HCZ equivalent

A

50 mg/day

82
Q

Moderate procedure periop steroid dosing

A

50 mg before cut, 25 mg q8 for 24 hours

83
Q

Moderate procedure target HCZ equivalent

A

75-150 mg/day

84
Q

Major procedure periop steroid dosing

A

100 mg before cut, continuous infusion of 200 mg over 24 hours

85
Q

Echinacea

A

Immunosuppressive; may cause allergic reactions intraoperatively

86
Q

Ephedra

A

Increased HR and BP; unresponsive to ephedrine; stop 24 hours before

87
Q

Garlic

A

Antiplatelet, anti HTN; increase risk of bleeding; stop 7 days before

88
Q

Ginger

A

Antiemetic, antiplatelet; stop 7-14 days before

89
Q

Gingko

A

Antiplatelet; stop 36 hours before

90
Q

Ginseng

A

Antiplatelet, lower BG; stop 7 days before

91
Q

Green tea

A

Antiplatelet. TXA2; stop 7 days before

92
Q

Kava

A

Anxiolytic, sedation; stop 24 hours before

93
Q

Saw palmetto

A

Inhibits COX and 5a reductase

94
Q

SJW

A

NT reuptake inhibition, delays emergence; stop 5 days

95
Q

Valerian

A

Sedation

96
Q

Post pyloric tube feeds may be stopped

A

Just prior to surgery on non abdominal surgeries

97
Q

At 8 hours you can eat

A

A full meal

98
Q

At 6 hours you can eat

A

A ligh meal; toast and liquids, infant formula, nonhuman milk, coffee

99
Q

At 4 hours babies can

A

Have breast milk

100
Q

At 2 hours you can have

A

Clear liquids; may be encouraged to drink a sports drink on the way to surgery

101
Q

Mendelson syndrome

A

Increased risk of aspiration; > 25 mL with a pH < 2.5

102
Q

Simplified Apfel Score

A

Female, Hx of PONV/motion sickness, nonsmoking, postop opioids

103
Q

All patients should receive abx

A

Within 1 hour of surgical incision - 45 minute window

104
Q

Patients who receive ______ or ______ should have abx initiated __ hours before surgery

A

Vancomycin; flouroquinolone; 2

105
Q

Most commonly administered abx for surgery

A

Ancef (cefazolin)

106
Q

Cefazolin redosing interval

A

q4 hours

107
Q

Clindamycin redosing interval

A

q6 hours

Assessment Exam 1 (5 decks)

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