Pre-Op Evaluation Flashcards
When does pre-op clearance need to be completed prior to surgery
elective and emergent
within 30 days of procedure (If elective)
during admission (if emergent)
What constitutes high risk procedures
> 5% risk for mortality/MI
emergent procedures
Aortic/major vascular procedures
peripharal vascular procedures
What consitutes a intermediate risk procedure
1 to 5% risk
head/neck procedures
carotid endaterectomy
most ortho procedures
prostatectomy
intraperitoneal/intrathoracicc surgery
what constitutes low risk procedures
<1% risk
endoscopic procedures
arthroscopic procedures
Laparoscopic surgerys
breast surgery excluding reconstructions
cataract surgery
superficial procedures
What is ASA score
American Society of Anesthesiologist score for patient classification
Higher ASA score = Greater general risk
What is included in a preop H&P
HPI
PHM
FH
SH
Allergies
Meds
Vitals
ROS
Exam
Labs/dx studies
Dx
TX plan
What are specific items to note in allergies for preop H&P
latex
betadine/iodine
antibiotics
What is a major concern with anesthesia
malignant hyperthermia
what is obtained for ROS on preop H&P
full ROS if elective
pertinent if emergent/able to obtain
who should complete initial surgical consent
the surgeon or resident
PA’s can act as a proxy but it is a much grayer area
What is the STOPBANG questionnaire
used for patient with OSA for preop
What are patient with ETOH disordered use at increased risk of with surgery
post operative complications
-particular concern for withdrawal for longer hosptial stays (>3d)
-consider covering with Benzo PRN = CIWA protocol
how long will Nicotine be positive after discontinuing
6+ weeks
What are big medical comorbidities that need to be adressed during preop
CVD/HTN
Anticoagulation
DM
Rheumatologic diseases
when should ASA/Plavix be discontinued prior to surgery
7 days prior
what are the recommendations for newer anticoagulants (Xa inhibitors) prior to surgery
discontinue 2-3 days pre-op
resume according to surgeons preference
What are the recommendations with Coumadin prior to surgery
discontinue 5 days prior to surgery
+/- Lovenox bridging
resume according to surgeons preference
What is the CHADS-VASc
Congestive HF
HTN
Age >75
DM
Stroke/TIA
Vascular dz
Age 75-74
Sex category (female)
lovenox bridge if score > 5
what can increase blood glucose
trauma
surgery
general anesthesia
some meds
what is the concern with hyperglycemia with surgery
increased risk of infection and cardiac complications
what are the concerns with hypoglycemia with surgery
increased risk of arrhythmias, cardiac events, transient cognitive changes
what is the target A1C of a patient with known DM
< 7%
target peri-op glucose: 110-180 mg/dL
when should oral hypoglycemic agent and non-insluin injectables be held prior to surgery
hold AM of surgery
resume most when patients resume PO intake
When should insulin be held prior to surgery
hold all short acting agents morning of surgery
continue basal insulin and insluin pumps
what do Rhematologic conditions increase the risk of regarding to surgery
cardiovascular risk increases
SSI (Surgical site infection)
how are rhematologic diseases often managed and what is the risk associated with this management
Corticosteroids- increased risk of SSI, poor wound healing, peri-op adrenal insufficiency
Non-biologics - increase risk of SSI and poor wound healing
biologics
If patient is on chronic steroids prior to surgery, what should be ordered
pre-op c-spine x-ray
risk of fx/SCI with forced neck extension for intubation
What are the common non-biologic immunomodulators
methotrexate
hydroxychloroquine
what is the timing of surgery for a patient on a biologic
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
when should NSAIDs be discontinued prior to surgery
7 days due to increased bleeding risk
What is ERAS protocols
Enhanced Recovery After Surgery Protocols
multi-modal, EBM team approach to peri-operative care
best practice guidelines
What is included in the brief op note
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
