Pre-op history and physical Flashcards
surgical removal of the lining of an artery
endartectomy
most commonly performed peripheral vascular operation in the US
carotid endartectomy
Indications for carotid endartectomy
symptomatic dz w/greater than 50% stenosis or asymptomatic dz w/greater than 80% stenosis
most important thing about the preoperative history and physical
assessing cardiac risk
the leading cause of perioperative death
cardiovascular events
Within what timeframe does JCAHO require a full H&P prior to surgery?
within 30 days
The decrease in tidal volume caused by general and spinal epidural anesthesia can cause atelectasis. What do you do post-op to prevent this?
incentive spirometry
How long can ADH be elevated post-operatively?
one week
Common herbal therapies that are platelet inhibitors
ginseng, garlic, gingko
What allergy is associated with foods including: bananas, avocados, kiwis, apricots, melons, and chestnuts?
latex
great tool to use for assessing functional status. The ability to perform greater than 4 metabolic equivalents has been associated with a lower cardiovascular risk
Duke Activity Status Index
What are the components of the Lee Index to assess for major cardiac complications (1 pt each)?
high risk surgery, h/o IHD, h/o congestive heart failure, h/o stroke or TIA, insulin DM, Cr > 2
How many points for the Lee Index have a complication rate of 11%?
3 or more
In these patients surgery should be delayed until the coronary artery disease is treated, if possible. If recent MI, delay 3-6 months.
high risk patient with CAD
significantly increases the risk of perioperative pulmonary edema (15%) and death (2-10%)
decompensated CHF
Decreases risk of pulmonary edema and perioperative death for patient with CHF
afterload reducers and diuretics
What would you do if you heard a murmur in the patient who has come in for a routine preoperative history and physical?
echo
level of HTN associated with a higher risk of cardiac complications
> 180/110
risk of developing these complications highest in patients undergoing cardiac, thoracic and upper abdominal surgery
pulmonary
the three patient specific factors associated with increased risk of postoperative pulmonary complications are
chronic lung dz, morbid obesity, tobacco use
how long must a patient have quit smoking for it to reduce risk of pulmonary complications in patients undergoing CABG?
8 weeks
Important in patients with lung disease esp those undergoing pelvic or hip sx
DVT prophylaxis
two most common serious neurological side effects of surgery
delirium and stroke
Medications associated with delirium
meperidine, anticholinergics, benzos
Patients with what condition are at increased risk for post-op infections and MIs
diabetics
Goal range for blood sugar levels of diabetics perioperatively
100-250 mg/dL
This should be considered in any patient who has been on 7.5 mg of prednisone for three weeks or 20 mg prednisone for a week
glucocorticoid replacement
What should a patient receive if there is evidence of adrenocortical insufficiency?
100mg of hydrocortisone every 8 hours beginning on the morning of surgery and continuing for 48-72 hours. Tapering the dose is not necessary.
These patients are at high risk for perioperative complications such as postoperative hyperkalemia, pneumonia and fluid overload
renal disease
T/F most prescription meds should be continued on the morning of surgery with small sips of water, unless specifically contraindicated
true
Medications that are usually withheld the day of surgery because their MOA involves the kidneys
ACE inhibitors and diuretics
When should herbal supplements be discontinued prior to surgery?
2 weeks
as a general rule, a patient taking warfarin may have surgery as long as the INR is less than what?
1.5
What should all patients with cardiovascular risk factors receive perioperatively?
beta blockers
