Pre-operative evaluation review Flashcards
What baseline functional status deems a patient able to undergo major abdominal/vascular surgery?
patient can maintain 4 mets (walking up a flight of stairs unassisted)
When would you get further cardiac testing for a patient before major surgery?
- cannot muster 4 METs (cannot walk up a flight of stairs
2. has at least 3 of the following: CAD, CHF, occlusive cerebrovascular disease, DM, CKD
When should you refer a patient to a cardiologist before major surgery?
Active heart disease
- unstable coronary disease
- decompensated heart failure
- significant cardiac arrhythmia
- significant valvular disease
What additional tests would you order for a patient with COPD prior to major surgery?
think about the following:
- ABG
- PFTs
Which are the branched amino acids?
- valine
- leucine
- isoleucine
What would PFTs look like on a morbidly obese patient
- decreased functional residual capacity
- decreased vital capacity
- decreased total lung capacity
Components of CHADS2 score
- CHF
- hypertension
- Age > 75
- Diabetes
- previous stroke (worth 2 points)
When would you bridge patient with AF prior to surgery?
CHADS2 score > 3-4
best pre-op nutritional marker
serum albumin (want it > 3.5)
Patient is going for an elective surgery, but is on dabigatran, when do you stop it?
- if Cr/CL > 50 2 days before, if < 50 then 3-5 days before surgery
Physiologic changes with CO2 insufflation
- decrease in venous return
- increase in SVR
- increase in MAP with decrease in CO/CI
who does not need stress dose steroids before surgery, if they are taking steroids?
- if amount is < 5 mg/day
- if they have been on the steroids for < 3 weeks
Perioperative steroid supplementation for chronic steroid users
- routine abdominal, peripheral vascular, orthopedic
50 mg IV hydrocortisone -> 25 mg IV hydrocortisone q8h for 24 hours -> continue home dose - Major surgery (resection of solid organ, central vascular surgery, cardiac surgery)
100 mg IV hydrocortisone -> 50 mg IV hydrocortisone q8h for 24 hours -> taper till you reach home dose (down by half every day)
What does Renin do?
cleaves angiotensin I from antiogenisnogen
how do you treat malignant hyperthermia?
stop the anesthetic give dantrolene (ryanodine antagonist)
What is succinylcholine metabolized by?
plasma pseudocholinesterase
patient on oral hypoglycemic agent, short acting insulin, and long acting insulin…on day of surgery what do they take?
- stop oral agent
- stop short acting insulin
- half dose of long acting insulin
what causes the classic sign of peri-umbilical pain then right lower quadrant pain of appendicitis?
- luminal dissension of appendix causes diffuse visceral pain
- once appendix touches peritoneum you get RLQ pain
another name for omega-3 fatty acids
alpha-linolenic acid
decision making ladder for patient with phimosis and difficulty placing foley
- if there is swelling use ice
- dilation of foreskin with kelly clamp
- dorsal slit circumcision
two kinds of local anesthetic used in small procedures?:
amino esters
amino amides
with which kind of local anesthetic are anaphylactic reactions more common?
amino esters
what is the proposed mechanism for allergic reaction with amino esters?
build up of para-aminobenzoic acid
which type of heparin do we use in vascular surgery?
typically unfractionated heparin because its quick on an off…in case you need to go back to the OR, among other benefits
how do you monitor UFH levels?
through aPTT of anti-Xa activity
how do you reverse heparin
protamine infusion
Sheehan syndrome
hypopituitarism secondary to gland necrosis in the setting of previous hypotension
most common electrolyte abnormality in Sheehan syndrome
hyponatremia
how does adding epinephrine help with local anesthesia?
epinephrine causes vasoconstriction which reduces absorption of anesthetic increasing the duration
