Pre-op Eval and Meds Flashcards
ASA Class?
Healthy patient without disease (organic, biochemical, or psychiatric)
ASA Class 1
ASA class?
Pt with mild systemic disease (mild asthma, well controlled HTN)
- no impact on daily activity, low likelihood of impact on surgery/anesthesia
ASA Class 2
ASA Class?
Significant or severe systemic disease that limits normal activity (CHF class 2, CRD on dialysis) - impacts daily activity, likely to impact anesthesia/surgery
ASA Class 3
ASA class?
Severe disease that is a constant threat to life/requires intensive therapy (acute MI, respiratory failure on mech vent)
- serious limitation of daily activity, major impact on surgery/anesthesia
ASA Class 4
ASA Class?
Moribund patient likely to die in next 24 hrs with or without surgery
ASA Class 5
ASA Class?
Brain-dead organ donor
ASA Class 6
Major steps in eval of cardiac risk for non-cardiac surgery
step 1- urgency of surgery
step 2- active cardiac conditions (acute MI, unstable/severe angina, decompensated CHF, severe valve disase, significant arrhythmia)
step 3- surgical risk/severity
step 4- eval functional capacity in METs
Step 5- eval patient with poor/indeterminate FC needing intermediate risk or vascular surgery
- Clinical predictors help assess risk (CAD, CHF, CVA, DM, renal disease
Define active cardiac conditions
acute MI unstable/severe angina decompensated CHF severe valve disase significant arrhythmia
**all warrant postponing surgery except for life saving emergency
What is focus of patient with emergency surgery needed and cardiac history?
- Periop surveilance (enzymes, EKG, monitoring)
2. Risk reduction (B blocker, statin, pain management)
Pt has no active cardiac condition. What do you do if…
- low risk surgery
- proceed w/ surgery w/out additional testing
Major components of pre-op history
- prior surgery/anesthesia (any issues?)
- med allergies
- current meds
- heart history and recent cardiac testing
- smoking/etoh/illicits
- steroids (for stress dosing)
- functional capacity (flights of stairs)
- HTN, DM, pulm disease, bleeding disorders, liver/kidney disease, jaw/neck/back disease, thyroid disease, neuro disease
- LMP-possibility ofpregnancy
- dental disease/chipped teeth/loose teeth
- OSA/snoring
Climibing 1-2 flights of stairs = ? METS
walking 1-2 blocks?
5 METS
3 METS
Major components of airway exam? 10 major parts
- Condition of Teeth
- Incisor eval (length of upper, relationship of upper to lower)
- ability to protrude mandibular incisors in front of upper
- tongue size
- visibility of uvula
- facial hair
- compliance of mandibular space
- thyromental distance w/ maximum head extension
- length/thickness of neck
- ROM of neck
Define low risk surgery
superficial or endoscopic
cataract surgery
breast surgery
ambulatory surgery
For how long should you delay elective surgery after DES? BMS?
DES- 1 year (d/c plavix but continue ASA if possible)
BMS - 1 month
When should you stop ASA before intracranial surgery?
7 days before operation
Which surgeries have high risk of bleeding in a closed space? (i.e. d/c asa or plavix if at all possible)
- intracranial neurosurg
- intramedullary canal surgery
- posterior eye chamber optho surgery
When is echo helpful in evaluating a murmur?
- high risk valve disease (elderly, CAD, rheumatic fever, increased volume overload, pulm disease, cardiomegaly, abnormal EKG)
- if spinal anesthesia is planned
Stenotic vs regurgitant valve disease; which is tolerated better intraop?
regurgitant
Which patients is it reasonable to eval LV function preoperatively?
- dyspnea of unknown origin
2. current/previous HF w/ worsening dyspnea/clinical status change in last 12 months without echo
Patients that require antibiotic prophyaxis after dental procedure w/ manipulation of gingival tissue/periapical region of teeth/perf of oral mucosa
- prosthetic cardiac valve
- previous infect endocarditis
- congenital heart disease (unrepaired cyanotic, completely repaired congenital w/ prosthetic material/catheter, repaired CHD w/ residual defects)
- cardiac valvulopathy in transplant patient
BP goal (max) to continue w/ surgery in patient with HTN
180/110
Patient related factors increasing postop pulm complications (PPC) - grade A only
advanced age ASA Class > 2 CHF Functionally dependent COPD
(others impaired sensorium, OSA, DM, obesity, smoking)
Procedure related factors increasing risk of PPC
- AAA repair
- thoracic surgery
- abdominal surgery
- upper abdominal surgery
- neurosurgery
- prolonged surgery
- head and neck surgery
- emergency surgery
vascular surgery
general anesthesia
