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
what do Rhematologic conditions increase the risk of regarding to surgery
cardiovascular risk increases SSI (Surgical site infection)
24
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
25
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
26
What are the common non-biologic immunomodulators
methotrexate hydroxychloroquine
27
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
28
when should NSAIDs be discontinued prior to surgery
7 days due to increased bleeding risk
29
What is ERAS protocols
Enhanced Recovery After Surgery Protocols multi-modal, EBM team approach to peri-operative care best practice guidelines
30
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