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Anesthesia Principles 1 > Pre-op Assessment > Flashcards

Pre-op Assessment Flashcards

1
Q

Risk of perioperative MI in general public

A

0.3%

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2
Q

Risk for reinfarction for patient with previous MI

A

> 6 months ago = 6%
3-6 months ago = 15%
< 3 months ago = 30%

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3
Q

Highest risk of reinfarction of MI is greatest _______.

A

within 30 days of acute MI

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4
Q

ACC/AHA guidelines to wait for elective surgery after recent MI

A

Wait 4-6 weeks

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5
Q

Greatest risk for non-cardiac surgery MI

A

Aortic Stenosis
-14X increase of perioperative mortality

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6
Q

What type of angina increases a pts risk for an MI with surgery and anesthesia

A

Unstable Angina

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7
Q

METS are a quick way to assess

A

CV function
-** you want at least 4 METs (Can you walk up a flight of stairs without getting short of breath?)

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8
Q

Risk of pulmonary complications increases as surgical site approaches the _______.

A

diaphragm and increased length of surgery (>2-3 hrs.)

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9
Q

OSA pearls

A

-can make pts difficult to mask ventilate
-have them bring CPAP for PACU
-don’t extubate deep
-minimize opioids and versed use

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10
Q

Asthma patient can have _______ preoperatively.

A

BRONCHOSPASM
-Have pt use their inhaler prior to induction

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11
Q

Red Flag for asthmatic pt

A

recent asthma attack!

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12
Q

High risk for aspiration equals _______.

A

RSI

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13
Q

Aspiration risks

A

-Small bowel obstruction
-Active nausea and vomiting
-GERD
-Hiatal hernia
-DM
-Ascites
-Pervious gastric bypass (DO NOT PUT NG or OG in these pts)
-Obesity
-Pregnancy

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14
Q

What is Mendelson syndrome?

A

chemical pneumonitis due to aspiration

-Aspirate Gastric Volume- >25mL
-pH <2.5
-Particulate aspirate > clear aspirate

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15
Q

DM general rules

A

-Hold oral diabetic medication morning of surgery (metformin 48 hours prior to surgery)

-Take ¼- ½ of insulin

-Check BG upon arrival and intra-op if procedure is long

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16
Q

What is Pheochromocytoma?

A

Hypersecreting tumors that secrete excess catecholamines

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17
Q

Catecholamines secreted from Pheochromocytoma

A

Primarily norepinephrine and some epinephrine

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18
Q

S&S of Pheochromocytoma

A

-Paroxysmal hypertension, Triad of diaphoresis, tachycardia, and headache, Tremulousness, Weight loss, Decreased intravascular volume, Orthostatic hypotension, HCT >45%

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19
Q

Surgical Hx concern for difficult intubation

A

-neck dissection
-laryngeal surgery (CA +radiation, chemo)
-previous trach
-c-spine surgery

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20
Q

How long to reduce acute effects of nicotine?

A

12-48hrs

21
Q

How long for smokers to have better pulmonary mechanics

A

8 weeks

22
Q

Acute cocaine use =

A

DON’T give beta-blocker, use calcium channel blocker instead

23
Q

Marijuana use=

A

more anesthesia, increased airway reactivity

24
Q

Narcotic use =

A

more anesthesia and increased opioid requirement d/t increased tolerance

25
Q

ASA classes

A

1- healthy
2- BMI 30-40
3- BMI >40
4- Surgery is constant threat to life; CVA, TIA, MI <3 months,
5- NEED surgery to survive; AAA, trauma, MODS
6- brain dead, organ donor

26
Q
A
27
Q

Most common cause of intraop allergic reaction

A

Rocuronium

28
Q

IV contrast dye and protamine cross reactivity

A

Shellfish

29
Q

Do not stop for surgery (reduces risk of peri-op ischemia

A

Beta-blockers

30
Q

Increases bleeding

A

garlic, ginkgo biloba, ginseng, fish oil

31
Q

Decrease anesthesia needs:

A

kava kava, valerian root

32
Q

ASA hold time

A

7 days

33
Q

NSAIDs hold time

A

24-48 hours

34
Q

Clopidgrel

A

5-7 days

35
Q

When do always get platelet count?

A

Spinal or epidural

36
Q

NPO guidelines

A
37
Q

STOP-BANG

A
38
Q

PUSH

A
39
Q

Laryngoscopy may be more difficult if the TMD is _______.

A

less than 6 cm (3 finger breadths) or greater than 9 cm

40
Q

Less than 6 cm (TMD)

A

-mandibular hypoplasia
-small mandibular space

41
Q

Greater than 9 cm (TMD)

A

-larynx more caudal

42
Q

Mandibular Protrusion Test (Upper Lip Bite Test)

A
43
Q

The ability to place the patient into sniffing position is highly dependent on the mobility of the _______.

A

Atlanta-occipital joint

44
Q

Normal AO flexion and extension

A

90-165 degrees

45
Q

Normal AO extension

A

35 degrees (laryngoscopy will be difficult if < 23 degrees)

46
Q

3-3-2 rule

A

-inter-incisor gap < 3 finger breadths
-thyromental distance < finger breadths
-Thyrohyoid < 2 finger breadths

47
Q

Conditions that impair AO mobility

A

-degenerative joint disease
-rheumatic arthritis
-ankylosing spondylitis
-trauma
-surgical fixation
-klippel-feil
-Down syndrome
-DM

48
Q

Pneumonics

A

Anesthesia Principles 1 (11 decks)

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