Pre-op Assessment Flashcards
Risk of perioperative MI in general public
0.3%
Risk for reinfarction for patient with previous MI
> 6 months ago = 6%
3-6 months ago = 15%
< 3 months ago = 30%
Highest risk of reinfarction of MI is greatest _______.
within 30 days of acute MI
ACC/AHA guidelines to wait for elective surgery after recent MI
Wait 4-6 weeks
Greatest risk for non-cardiac surgery MI
Aortic Stenosis
-14X increase of perioperative mortality
What type of angina increases a pts risk for an MI with surgery and anesthesia
Unstable Angina
METS are a quick way to assess
CV function
-** you want at least 4 METs (Can you walk up a flight of stairs without getting short of breath?)
Risk of pulmonary complications increases as surgical site approaches the _______.
diaphragm and increased length of surgery (>2-3 hrs.)
OSA pearls
-can make pts difficult to mask ventilate
-have them bring CPAP for PACU
-don’t extubate deep
-minimize opioids and versed use
Asthma patient can have _______ preoperatively.
BRONCHOSPASM
-Have pt use their inhaler prior to induction
Red Flag for asthmatic pt
recent asthma attack!
High risk for aspiration equals _______.
RSI
Aspiration risks
-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
What is Mendelson syndrome?
chemical pneumonitis due to aspiration
-Aspirate Gastric Volume- >25mL
-pH <2.5
-Particulate aspirate > clear aspirate
DM general rules
-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
What is Pheochromocytoma?
Hypersecreting tumors that secrete excess catecholamines
Catecholamines secreted from Pheochromocytoma
Primarily norepinephrine and some epinephrine
S&S of Pheochromocytoma
-Paroxysmal hypertension, Triad of diaphoresis, tachycardia, and headache, Tremulousness, Weight loss, Decreased intravascular volume, Orthostatic hypotension, HCT >45%
Surgical Hx concern for difficult intubation
-neck dissection
-laryngeal surgery (CA +radiation, chemo)
-previous trach
-c-spine surgery
How long to reduce acute effects of nicotine?
12-48hrs
How long for smokers to have better pulmonary mechanics
8 weeks
Acute cocaine use =
DON’T give beta-blocker, use calcium channel blocker instead
Marijuana use=
more anesthesia, increased airway reactivity
Narcotic use =
more anesthesia and increased opioid requirement d/t increased tolerance
ASA classes
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
Most common cause of intraop allergic reaction
Rocuronium
IV contrast dye and protamine cross reactivity
Shellfish
Do not stop for surgery (reduces risk of peri-op ischemia
Beta-blockers
Increases bleeding
garlic, ginkgo biloba, ginseng, fish oil
Decrease anesthesia needs:
kava kava, valerian root
ASA hold time
7 days
NSAIDs hold time
24-48 hours
Clopidgrel
5-7 days
When do always get platelet count?
Spinal or epidural
NPO guidelines
STOP-BANG
PUSH
Laryngoscopy may be more difficult if the TMD is _______.
less than 6 cm (3 finger breadths) or greater than 9 cm
Less than 6 cm (TMD)
-mandibular hypoplasia
-small mandibular space
Greater than 9 cm (TMD)
-larynx more caudal
Mandibular Protrusion Test (Upper Lip Bite Test)
The ability to place the patient into sniffing position is highly dependent on the mobility of the _______.
Atlanta-occipital joint
Normal AO flexion and extension
90-165 degrees
Normal AO extension
35 degrees (laryngoscopy will be difficult if < 23 degrees)
3-3-2 rule
-inter-incisor gap < 3 finger breadths
-thyromental distance < finger breadths
-Thyrohyoid < 2 finger breadths
Conditions that impair AO mobility
-degenerative joint disease
-rheumatic arthritis
-ankylosing spondylitis
-trauma
-surgical fixation
-klippel-feil
-Down syndrome
-DM
Pneumonics
