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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
What does METs stand for
Metabolic Equivalent of Task
26
1 MET is equivalent to
3.5 mL/kg/min
27
1 MET
Eating, working at a computer
28
2 METs
Walking downstairs or cooking
29
3 METs
Walking 1 or 2 blocks on level ground
30
4 METs
Raking leaves, gardening
31
3 urgencies of surgery
Emergency, urgent, time-sensitive
32
Emergency surgery should be performed
When life or limb is threatened if surgery did not proceed within 6 hours or less; focus on surveillance
33
Urgent surgery
Life or limb would be threatened if surgery did not proceed within 6-24 hours
34
Time-sensitive surgery
1 to 6 weeks would adversely affect patient outcomes
35
Preoperative cardiac risk assessment algorithm
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
36
"Other" components of operative risk
Skill of surgeon, planned surgical procedure, attention to postoperative care (ICU bed availability), experience of the anesthetist
37
ASA I
Healthy, non smoking, no or minimal alcohol use
38
ASA II
A patient with mild systemic disease; Mild diseases only, without substantive limitations.
39
ASA III
A patient with severe systemic disease; Substantive functional limitations.
40
ASA IV
A patient with severe systemic disease that is a constant threat to life
41
ASA V
A moribund patient patient who is not expected to survive without the operation
42
ASA VI
A declared brain-dead patient whose organs are being removed for organ donor purposes
43
A patient classified as an ASA III might have which conditions?
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
A patient classified as ASA IV might have which conditions?
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
Who should get a pre operative CBC/H&H?
ASA 3 or 4 undergoing a moderate risk procedure or all patients undergoing a major surgery
46
Who should get pre op renal panels?
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
What is the focus of a renal panel for anesthetic purposes?
BUN and creatinine
48
What values does an iStat show us?
Na, K, Cl, CO2, BUN, creat, BG
49
Always get a chem panel after?
Dialysis
50
Who should get pre op coagulation studies?
ASA 3 and 4; known or suspected coagulopathy, known bleeding disorders, liver disease, and anticoagulant use
51
Who should get a pre op serum glucose and/or HbA1C?
Diabetics, obesity, cerebrovascular or intracranial disease, or steroids history
52
Which procedure would we cancel if the patient had a UTI?
Ortho procedures
53
What should we avoid in pregnant women (early) as to not cause teratogenicity?
Benzo's and NO
54
What might cause a wide mediastinum?
Aortic rupture, tamponade, ruptured esophagus
55
General anesthesia per PP
Total loss of consciousness and airway control
56
Name the most common allergies in order from most allergies to least
NMDB (Roc #1), latex, CHG, abx, opioids
57
Which disease process should we expect a latex allergy in?
Spina Bifida
58
Which foods have cross-reactivity with latex?
Kiwi, mango, banana, avocado, passion fruit, chestnuts
59
Amide LAs
Have two Is (lidocaine)
60
Ester LAs
Have one i (procaine)
61
Ester reactions in some LAs are due to
PABA (para-aminobenzoic acid)
62
What causes the allergy in NMDBs
The quaternary ammonium compounds
63
What medications do we tell patients to continue before surgery?
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
What medications do we ask patients to stop before surgery?
P2Y12 inhibitors (clopedigril, ticagrelor, prasugrel), diuretics, sildenafil (unless it's for pulm HTN), NSAIDs, coumadin, HRT, non insulin diabetics, SGLT2 inhibitors
65
When should you stop clopedigril and ticagrelor?
7-10 days pre op
66
When should you stop prasugrel?
10 days pre op
67
When should you stop diuretics?
The day of - keep taking HCTZ
68
When should you stop sildenafil?
24 hours pre op
69
When should you stop taking NSAIDs?
48 hours
70
When should you stop coumadin?
5 days pre op
71
When should you stop HRT?
4 weeks pre op
72
When should you stop non insulin anti diabetics?
Day of
73
When should you stop SGLT2 inhibitors?
24 hours pre op
74
What does of long acting insuling should type I diabetics take on the day of surgery?
1/3
75
What dose of long acting/combo insulin should type II diabetics take on the day of surgery?
None or 1/2
76
Why do we worry about patients on long term steroid therapy?
They may not release cortisone in response to stress - adrenal glands don't work as well
77
If the patient is on low dose, short duration steroids we usually give them
4-8 mg decadron
78
Stress dose steroids are typically
100 mg HCZ q8 for 24 to 48 hours
79
HPA suppression common with what steroid regimen?
> 20 mg steroid/day for at least 3 weeks
80
Minor procedure periop steroid dosing
50 mg before cut, 25 mg q8 for 24 hours
81
Minor procedure target HCZ equivalent
50 mg/day
82
Moderate procedure periop steroid dosing
50 mg before cut, 25 mg q8 for 24 hours
83
Moderate procedure target HCZ equivalent
75-150 mg/day
84
Major procedure periop steroid dosing
100 mg before cut, continuous infusion of 200 mg over 24 hours
85
Echinacea
Immunosuppressive; may cause allergic reactions intraoperatively
86
Ephedra
Increased HR and BP; unresponsive to ephedrine; stop 24 hours before
87
Garlic
Antiplatelet, anti HTN; increase risk of bleeding; stop 7 days before
88
Ginger
Antiemetic, antiplatelet; stop 7-14 days before
89
Gingko
Antiplatelet; stop 36 hours before
90
Ginseng
Antiplatelet, lower BG; stop 7 days before
91
Green tea
Antiplatelet. TXA2; stop 7 days before
92
Kava
Anxiolytic, sedation; stop 24 hours before
93
Saw palmetto
Inhibits COX and 5a reductase
94
SJW
NT reuptake inhibition, delays emergence; stop 5 days
95
Valerian
Sedation
96
Post pyloric tube feeds may be stopped
Just prior to surgery on non abdominal surgeries
97
At 8 hours you can eat
A full meal
98
At 6 hours you can eat
A ligh meal; toast and liquids, infant formula, nonhuman milk, coffee
99
At 4 hours babies can
Have breast milk
100
At 2 hours you can have
Clear liquids; may be encouraged to drink a sports drink on the way to surgery
101
Mendelson syndrome
Increased risk of aspiration; > 25 mL with a pH < 2.5
102
Simplified Apfel Score
Female, Hx of PONV/motion sickness, nonsmoking, postop opioids
103
All patients should receive abx
Within 1 hour of surgical incision - 45 minute window
104
Patients who receive ______ or ______ should have abx initiated __ hours before surgery
Vancomycin; flouroquinolone; 2
105
Most commonly administered abx for surgery
Ancef (cefazolin)
106
Cefazolin redosing interval
q4 hours
107
Clindamycin redosing interval
q6 hours

Assessment Exam 1 (5 decks)

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