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باطنه > Pre Operative 2 > Flashcards

Pre Operative 2 Flashcards

1
Q

What u should do before deciding if patient can go or not to surgery?

A

After history, physical examination, investigation

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2
Q

What is the criteria of patient that ready for surgery?

A 
1- he fits anaesthesia
2- optimized physical condition
3-almost possible correction
4-high emergent
5- pt gives legal consent
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3
Q

When u till the patient to postpone the surgery?

A 
1-not fit the anaesthesia
2-ont optimized physical condition
3-not not almost possible correction
4-not emergent
5- have no legal consent
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4
Q

How many classes in ASA??

A

6

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5
Q 
رتب
1-sever systemic disease ( sDM, COPD) 
2-healthy mormally patient
3-mild systemic disease
4- declared brain dead
5-incapacitating systemic disease
6-moribund patients not expected to survive 24hrs
A 
CLASS lll
Class I
Class II
CLASS E
CLASS IV
CLASS V
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6
Q

In general, what is pre operative optimization?

A
  1. Any fluid or electrolyte imbalance should be corrected
  2. Extent ot existing comorbidities should understood, condtions should be optimized prior to surgery
  3. Medications need adjustment
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7
Q

Enumerate steps of pre operative optimization of medications?

A

Pre operative medications to
1. Conseder
Stop
Adjust

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8
Q

Enumerate preoperative medications to stop?

A
  1. ORAL ANTIHYPERGLYCEMIC DRUGS
  2. ACEIS AND ARB
  3. WARFARIN AND HEPARIN
  4. NSAIS AND ASPIRIN
  5. HERBAL SUPPLEMENTS
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9
Q

Enumerate pre operative medications to consider?

A

Prophylaxis :

  1. GE REFLUX : RANITIDINE, METOCLOPRAMIDE, NA CITRATE
  2. ANTIBIOTICS : INFECTIVE ENDOCARDITIS
  3. STEROIDS FOR ADRENAL INSUFFICIENT
  4. ANXIETY :BENZODIAZEPINES
  5. BRONCHODILATOR: COPD AND ASTHMA
  6. NITROGLYCRIN and B BLOCKERS FOR CAD
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10
Q

To adjust??

A

BRONCHODILATOR
PREDNSONE
Insulin ( insulin)/dextrose infusion or holding dose

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11
Q

Which diseases complications continue to account for major morbidity and
mortality in patients undergoing noncardiac surgery?

A

Cardiovascular and pumonary complications

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12
Q

Which blood pressure not independently risk factor for perioperative cardiovascular complications?

A

Systole less than 180

Diadtole < 110

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13
Q

Clarify pre operative optimization of CAD???

A

➢At least 60 day should elapse after a MI before a noncardiac surgery in the absence of a
coronary intervention
• This period carries an increased risk of re-infarction/death
➢Mortality with perioperative MI is 20-50%

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14
Q

What are the advantages and disadvantages s of b blocker in CAD patient!

A

Dicrease the risk of cardiac events and mortality rate.

Increase peri operative strokes

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15
Q

Continue -blocker if patient is…….

A

routinely taking it prior to surgery

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16
Q

Consider initiation of -blocker in????

A

1.CAD and other ondications

2 intermediate and high risk surgerys as vascular surgery

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17
Q

Enumerate high Risk factor assessment of Noncardiac Surgical Procedurs?

A
  1. high emergent with elderly 🧓
  2. prolonged surgery with high fluid shift/blood loss
  3. aortic and other non carotid vascular surgery ( endovascular and non endo…)
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18
Q

Enumerate lower Risk factor assessment of Noncardiac Surgical Procedurs?

A

Eye 👁‍🗨
Skin
Superficial surgery
Endoscopic procedures

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19
Q

Enumerate intermediate Risk factor assessment of Noncardiac Surgical Procedurs?

A
  1. head and neck 🧣
  2. Carotid endartrectomy
  3. Thoracic
  4. abdominal
  5. Orthopedic 🍖
  6. Prostate
20
Q

Enumerate adverse effects of smoking?

A

🚬

  1. Alter mucous secretion
  2. Dicrease small airway calibre
  3. Alter o2 carrying capacitiy
  4. Increase airway respond
  5. Alter immune response
21
Q

When the patient abstain smoking before surgery!

A

8 weeks

At least, 24 hrs enough to increase o2 availability in tissue

22
Q

What asthmatic patients need before surgery??

A
  1. Short course of ( corticosteriods+ B2 AGONIST INHALATION)
  2. Avoiding NON SELECTIVE B BLOCKER
  3. CAN TAKE CARDIOSELECTIVE B BLOCKER
23
Q

Enumerate 2 of CARDIOSELECTIVE b blocker?

A

Metoprolol

Atenolol

24
Q

When asthmatic patients should delay surgery???

A

1** Poorly controlled asthma
(COGH, HIGH SPUTUM PRODUCTION, ACTIVE WEEZING)
2** URTI

25
Q

Asthmatic patients with URTI should delay surgery for………..

A

6 weeks

26
Q

Enumerate condtions exacerbate COPD patients??

Then the their effects???

A 
Anaesthesia
Upper abdominal surgery
Pain
..........
Atelctasis
Bronchospasm
Pneumonia
Prolonged mech ventillation
Respiratory faliure
27
Q

Investigación should COPD patients do pre operative??? And why!!

A

ABG, to knlw baseline respiratory acidosis, plan the post operation management

28
Q

Which types of COPD need ABG?

A

II

III

29
Q

When COPD patients should cancel or delay the surgery??

A

Acute exacerbation

30
Q

Enumerate factors increase risk of aspiration!?

A
  1. ⬆️ Intra abdominal pressure
  2. ⬇️ Gastric emptying
  3. Spheincter incompetence
  4. ⬇️ Level of consciousness
  5. Unprotected airway
31
Q

How to manage aspiration??

A
  1. Manage risk factors if possible
  2. ⬇️ Gastric volume and acidity
  3. Protect airway(endotracheal tube)
  4. Delay inhibiting air way reflexes with MS relaxants
  5. Empoly rapid sequence induction
32
Q

Enumerate fasting guidlines prior to surgery!

A
  • 8 h after a meal that includes meat, fried or fatty foods
  • 6 h after a light meal (such as toast or crackers) or after ingestion of infant formula or nonhuman milk
  • 4 h after ingestion of breast milk
  • 2 h after clear fluids (water, black coffee, tea, carbonated beverages, juice without pulp)
33
Q

Put examples on :

⬇️ Level of consciousness??

A

CNS PATHOLOGY
HEAD TRUAMA
Shock/truama
DRUGS/ALCOHOL

34
Q

Put examples on :

⬆️ Abdominal pressure??

A

PREGNANCY 🤰
OBESITY
BOWEL OBSTRUCTION
ACUTE ABDOMEN

35
Q

Put examples on :

Delayed gastric empty??

A

DM
NARCOTICS
Non FASTED WITHIN 8 HRS

36
Q

Put examples on :

⬇️ Sphincter competance

A 
GERD
Hiatus hernia
Nasogadtric tube
Pregnancy 🤰
OBESITY
37
Q

In hematological disorders evaluate………..

A

Hb
Hematocrite
Coagulation proles

38
Q

In case of Anemia, preoperative treatment is……?? And by……???

A

⬆️ Hemoglobin
PO, IV iron supplements
Erythropoiten
Pre admission blood collection

39
Q

In coagulapathies, pre operative treatment is to stop……….. And may need to take……….

A 
Anticoagulants( warfarin, Aspirin, apixaban, clopidogrel, dabigatran) 
Reversal dugs( VIT. K, recombenant factor VII, prothrombin complex concentrats)
40
Q

In case of DM, be aware of end organ damage to……………?

A

CVS ♥
Renal
preiphral, central and autonomic nervous sys🧠

41
Q

Enumerate pre operative guidlines for DM!!?

A
  1. Verify target bl. Glucose
    ( ⬇️180 in critical cases,, ⬇️ 140 in stable cases)
  2. Insulin therapy
  3. Stop oral hypoglycemic drugs
  4. Cancel non emergent procedures if glucose > 400, HHS, DKA
42
Q

Treatment of hyñerthyroidism pre operative??

A

B blocker

Prophylactic ⚕

43
Q

Both obesity and………….. Independently ⬆️ risk of…………,………,………

A

OSA

  1. difficult ventillation, intubation
  2. post operative resp. Complications
44
Q

Hyper thyroidism can experience……… If not……….. Pre operative.

A

Thyroid storm

Treated or well controlled

45
Q

Thank you

A

⚕️⚕️⚕️⚕️

باطنه (2 decks)

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