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Clin Med IV: Geriatrics and Hospital Medicine > Pre-Op Evaluation > Flashcards

Pre-Op Evaluation Flashcards

1
Q

When does pre-op clearance need to be completed prior to surgery

elective and emergent

A

within 30 days of procedure (If elective)
during admission (if emergent)

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2
Q

What constitutes high risk procedures

A

> 5% risk for mortality/MI
emergent procedures
Aortic/major vascular procedures
peripharal vascular procedures

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3
Q

What consitutes a intermediate risk procedure

A

1 to 5% risk
head/neck procedures
carotid endaterectomy
most ortho procedures
prostatectomy
intraperitoneal/intrathoracicc surgery

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4
Q

what constitutes low risk procedures

A

<1% risk
endoscopic procedures
arthroscopic procedures
Laparoscopic surgerys
breast surgery excluding reconstructions
cataract surgery
superficial procedures

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5
Q

What is ASA score

A

American Society of Anesthesiologist score for patient classification
Higher ASA score = Greater general risk

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6
Q

What is included in a preop H&P

A

HPI
PHM
FH
SH
Allergies
Meds
Vitals
ROS
Exam
Labs/dx studies
Dx
TX plan

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7
Q

What are specific items to note in allergies for preop H&P

A

latex
betadine/iodine
antibiotics

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8
Q

What is a major concern with anesthesia

A

malignant hyperthermia

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9
Q

what is obtained for ROS on preop H&P

A

full ROS if elective
pertinent if emergent/able to obtain

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10
Q

who should complete initial surgical consent

A

the surgeon or resident
PA’s can act as a proxy but it is a much grayer area

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11
Q

What is the STOPBANG questionnaire

A

used for patient with OSA for preop

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12
Q

What are patient with ETOH disordered use at increased risk of with surgery

A

post operative complications
-particular concern for withdrawal for longer hosptial stays (>3d)
-consider covering with Benzo PRN = CIWA protocol

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13
Q

how long will Nicotine be positive after discontinuing

A

6+ weeks

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14
Q

What are big medical comorbidities that need to be adressed during preop

A

CVD/HTN
Anticoagulation
DM
Rheumatologic diseases

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15
Q

when should ASA/Plavix be discontinued prior to surgery

A

7 days prior

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16
Q

what are the recommendations for newer anticoagulants (Xa inhibitors) prior to surgery

A

discontinue 2-3 days pre-op
resume according to surgeons preference

16
Q

What are the recommendations with Coumadin prior to surgery

A

discontinue 5 days prior to surgery
+/- Lovenox bridging
resume according to surgeons preference

17
Q

What is the CHADS-VASc

A

Congestive HF
HTN
Age >75
DM
Stroke/TIA
Vascular dz
Age 75-74
Sex category (female)

lovenox bridge if score > 5

18
Q

what can increase blood glucose

A

trauma
surgery
general anesthesia
some meds

19
Q

what is the concern with hyperglycemia with surgery

A

increased risk of infection and cardiac complications

20
Q

what are the concerns with hypoglycemia with surgery

A

increased risk of arrhythmias, cardiac events, transient cognitive changes

20
Q

what is the target A1C of a patient with known DM

A

< 7%
target peri-op glucose: 110-180 mg/dL

21
Q

when should oral hypoglycemic agent and non-insluin injectables be held prior to surgery

A

hold AM of surgery
resume most when patients resume PO intake

22
Q

When should insulin be held prior to surgery

A

hold all short acting agents morning of surgery
continue basal insulin and insluin pumps

23
Q

what do Rhematologic conditions increase the risk of regarding to surgery

A

cardiovascular risk increases
SSI (Surgical site infection)

24
Q

how are rhematologic diseases often managed and what is the risk associated with this management

A

Corticosteroids- increased risk of SSI, poor wound healing, peri-op adrenal insufficiency
Non-biologics - increase risk of SSI and poor wound healing
biologics

25
Q

If patient is on chronic steroids prior to surgery, what should be ordered

A

pre-op c-spine x-ray
risk of fx/SCI with forced neck extension for intubation

26
Q

What are the common non-biologic immunomodulators

A

methotrexate
hydroxychloroquine

27
Q

what is the timing of surgery for a patient on a biologic

A

time elective procedure at the end of a dosing cycle (if every 4 weeks, OR on week 4)
traditionally, recommend holding 2 weeks prior to surgery
hold at least 2 weeks after surgery

28
Q

when should NSAIDs be discontinued prior to surgery

A

7 days due to increased bleeding risk

29
Q

What is ERAS protocols

A

Enhanced Recovery After Surgery Protocols
multi-modal, EBM team approach to peri-operative care
best practice guidelines

30
Q

What is included in the brief op note

A

pateint name, DOB, and MRN
porcedure date and time
preop dx
post op dx
procedure
+/- intra-op findings
implants (if applicable)
surgeon
Assistant(s) and attestation
Anesthesia
EBL
UOP
Fluids
Specimens
+/- tourniquet time
drains
complications
dispositions
surgeons attestations

Clin Med IV: Geriatrics and Hospital Medicine (8 decks)

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