Pre-operative Management Flashcards
What is included in Pre-Op Clearance?
This is generalized to fit across specialities
- Determination of surgical risk
- Pre-op H&P
- Pre-op labs
- Management of specific conditions
- Peri-op medication management
- Pre-procedure prophylaxis
- Surgical documentation
What mortality/MI risk qualifies the procedure as high risk?
> 5% risk for mortality/MI
What are some high risk procedures?
- > 5% risk for mortality/MI
- Emergent procedures
- Aortic/major vascular procedure
- Peripheral vascular procedures
What are considered intermediate risk procedures?
- 1-5% risk
- Head/neck procedures
- Carotid endarterectomy
- Most orthopedic procedures
- Prostatectomy
- Intraperitoneal/intrathoracic surgery
Laparoscopic procedures fall under what procedure risk catagory?
Low Risk
< 1% risk for mortality/MI
What should be included in the pre-op H&P
HPI, Vitals, ROS, Exam
* Include last oral intake
* Highlight previous episodes/treatment
* Clarify acute/sudden onset for emergent patients
* At least heart, lung and applicable systems; ideally full physical
PMH
* Medical co-morbidities
* Past surgical procedures/anesthesia
FH, SH
Allergies, Medications
Where you need to document appropriately so that insurance covers
What is malignant hyperthermia?
Where should it be documented in the pre-op H&P?
Anesthesia complication –> allergic reaction to anesthesia!
Family History or Allergies
What are some specific allergies to include in the allergy section of the pre-op H&P?
- Latex
- Betadine/iodine
- Antibiotics
Do you ask about herbal meds/supplements during the pre-op H&P?
Yes, this is pertinent information for the pre-op H&P because some can interact with meds/anesthesia, or increase bleeding risk
Kava Kava can prolong anesthesia
Initial surgical consent should be done by whom?
Who can act as a proxy?
The surgeon
Residents in an emergency
PAs as a proxy is much more of a grayer area
What surgery complications are associated or at higher risk due to obesity?
What is the goal BMI
Thromboembolism and infection
< 40
OSA increases what surgical complication risks?
Respiratory/cardiovascular complications
What is the STOPBANG questionnaire?
OSA screening questionnaire
What medication can be considered for alcohol withdrawal prophylaxis to avoid post-op complications (withdrawal)?
Benzodiazepines PRN
Is MAT designed for pain control?
NO! Doesn’t work for pain, pain medication post-op must go beyond current dose of opioids for pain relief
When using spinal/epidural anesthesia what lab value should be collected as part of pre-op labs?
Platelets
Order CBC
Hyperglycemia increases post-op complications in what procedures?
Cardiac, Vascular, and Ortho procedures
Cotinine is a by product of what?
When should it be ordered pre-op?
Nicotine
In smokers, nicotine users
How long can cotinine be measured in the system after quitting nicotine products?
Up to 6 weeks
When should a PT/INR be drawn during pre-op labs?
- Occassionally get as baseline
- Patients on Coumadin or with liver disease
- Neet to repeat screen day of surgery (fingerstick)
What nutrition marker can be drawn prior to surgery to evaluate nutritional status?
Is it specific?
Albumin/Pre-albumin
No, but the best we got
For patients that are MRSA or MSSA carriers what can be used to decolonize pre-operatively to reduce risk?
Mupirocin ointment and hibiclens pre-op
Who should have a pregnancy test prior to surgery?
When should a pregnancy test be ordered prior to surgery?
All women of childbearing age unless documented hysterectomy or tubal ligation
Morning of surgery
What patients should receive an EKG prior to surgery?
- Routine screening for patients age 45+
- High risk for cardiac event
