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Preanesthesia Evaluation > PreAnesth Eval > Flashcards

PreAnesth Eval Flashcards

1
Q

4 components of evaluation

A

Review of patient records / patient interview / focused medical exam / medical testing and eval

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2
Q

Characteristics of evaluation components

A

Patient interview: very important, assess awareness, MH, expectations etc / Physical Exam: not thorough, focused to card/pulm status. Medical testing: always f/u any abnormals, verifying conditions on H&P.

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3
Q

Timing of Important Tests

A

W/I 6 months - ECG, noninvasive tests, CXR W/I 1-3 months CBC W/I week coags, chemistries

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4
Q

Keys to Cardiac Eval

A

HTN controlled? / CAD=PVD=MI Hx (no sx if MI < 6 months / CHF/CM recent EF / Dysrhythmia/Pacer controlled HR, anticoag, syncope

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5
Q

Major Cardiac signs/symptoms

A

angina, claudication (=CAD), exercise tolerance (major!, 4-5 min goal/carrying groceries?), syncope, orthopnea/dyspnea (lay flat?)

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6
Q

ECG Testing pearls: Pt hx

A

ECG males= 40-45 yo, females= >50 yo / DM, HTN, obeses, CNS disease, smoker, pulm disease, family Hx, radiation therapy, High cholesterol / ECG w/i 30 days

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7
Q

ECG Testing pearls: Sx type

A

Resting ECG for any vascular sx / presence of risk factors (CHF, CAD, DM, CereVasc disease, renal insuff

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8
Q

What are considered active cardiac conditions?

Clinical Risk Factors?

A

unstable angina, recent MI, CHF active, significant arrhythmia, severe valvular disease // Hx ischemic heart, hx heart failure, Hx CVA, DM, renal insuff

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9
Q

Categories of Sx risk w/ CV problems

A

High: vascular surgery InterMed: intraperitoneal, intrathoracic, head/neck, ortho, prostate (invading cavities) Low: endoscopic, superficial, breast, ambulatory

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10
Q

CV system prep/planning per condition 1/2

A

HTN: cont meds, 180/110 or less, avoid ace-inh/ARB / CAD/angina: no HD extremes, no tachy, BB and ST seg monitor / CHF: poss invasive monitors, cont BB, MAPs 20% NL / PVD-BB rx (=CAD) / Dysrhythmia: consult for mgmt

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11
Q

CV system prep/planning per condition 2/2

A

Valve disease: specific to disease, fluid mgmt / CM: specific to type, fluid mgmt / pacemaker: avoid electrocautery, magnet around, poss get recent interrogation results

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12
Q

Pulm Conditions of interest

A

Asthma (degree, freq, hospital, PFTs) / COPD (PFTs) / OSA / Smoker (20+yrs = sig disease) / recent URI (at risk for complications / +PPD

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13
Q

Major Pulm signs/symptoms

A

exercise tolerance, dyspnea/orthopnea, cough/sputum production, wheezing

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14
Q

Pulm Testing

A

Asthma - PFT, peak flow / COPD - PFT, peak flow, CXR / OSA - sleep studies / smoking/infection - CXR

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15
Q

Pulm system prep/planning per condition

A

Asthma & COPD - bronchD, poss steroids / OSA - CPAP?, not ambu sx / smoker - cessation x8 wks / recent URI - delay sx, poss Abx

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16
Q

Pulm disease mgmt pearls

A

bronchospastic disease - give bronchoD priior to OR, think LMA, steroids of on already / OSA = CPAP in PACU / smokers - poss incr in mucous if recently stopped (2 weeks OK)

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17
Q

GI conditions of interest

A

GERD (clinically sig type), Obesity, Hepatic disease (ETOH, coag status, w/d?) / Malnutrition (poor healing/immune fxn, dehydration, low PRO effects) / ETOH abuse (varicies)

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18
Q

GI testing

A

Hepatic disease - LFTs, coags, albumin, CBC, glucose / Malnutrition - albumin, lymph, pre-alb / ETOH - combo of above / coags/alb more specific than LFTs

19
Q

GI System prep/planning per condition

A

Obese - AW issues, aspiration prophy, IS post op / GERD - RSI, aspiration prophy / Hepatic - vit-k, FFP, glucose mgmt, variceal bleed, enzyme induced / ETOH - use benzos (8 hr since last drink)

20
Q

Neuro Conditions of interest

A

Stroke/TIA/Carotid Disease (most important) / NM disease (MH risk), peri neuropathy (positioning), Sz (anesthetics lower threshold, PACU risk of sz, Rx enzyme inducing), arthritis, Connective tissue (SLE/scleroderma produce end organ disease)

21
Q

Neuro Testing

A

Stroke/TIA req work up / Carotid disease (poss duplex ??)

22
Q

Neuro System prep/planning per condition

A

Stroke - ? use of Succs with incr K risk, use nerve stim on NL side / TIA/Carotids - req strict BP mgmt / NM disease - avoid succs, MH trigger, close monitoring / arthritis/PeriNeuropathy - careful positioning

23
Q

Renal/GU conditions of interest

A

Only renal failure/insuff and pregnancy

24
Q

Renal/GU testing

A

CRF - caogs, cbc, CMP, UA, Cr clearance (best renal fxn test) / Prego - serum hcg (must watch for intraop hypotension/hypoxia, no benzos/N2O)

25
Q

Renal/GU system prep/planning per condition

A

CRF - dialysis day before or day of sx, +/- transfusion or epo, consider DDAVP, careful mgmt of fluid/lytes / prego - cancel/delay sx, want 2nd trimester (1=organogenesis/3=risk PTL), no N2O, benzos, no hypotension/hypoxia

26
Q

Endocrine conditions of interest

A

DM, Hypo/Hyper Thyroid (mostly hypothy, mild-mod has little clinical effects) / Adrenocortical insuff

27
Q

Endocrine Condition Testing

A

DM - glucose (current mgmt), HbA1C for end organ assessment, lytes, renal / Thyroid/Adrenal - lytes

28
Q

Endocrine system prep/panning per condition: DM

A

DM - glucose control, no hypoglycemia (reduced dosing), know current regimen, “prayer sign” = neck arthritis, gastroparesis = ANS dysfxn, type 1 at risk ketoacidosis/type 2 hyperosmolar risk

29
Q

Endocrine system prep/panning per condition: Hypothyroid/hyperthyroid // adrenal insufficiency

A

hypo: Can hold levothyroxine, severe disease may need supplement, at risk for hypoglycemia/hypovent/hypothermia // hyper: risk for thyroid storm, hyperPTH=excess calcium

30
Q

Endocrine system prep/panning per condition: adrenal disorder

A

d/t long term steroid use / cushing syndrome, need IVF (typical hypovolemic) and lytes (sodium loss) // pheo: unexplained HTN, HA, tachy & sweaty

31
Q

Hematologic System testing

A

Anemia: CBC, coags, T&S, T&X / Coag Disorder: coag studies, T&S, T&X / Hgb Disorders: Sickle = h/h, T&S, T&X / Thaless = varies

32
Q

Hematological system prep/panning per condition:

A

Anemia - transfusion, erythroPOT, iron / Coag - congenital replace specific Fx deficit, hold culprit meds, reverse as needed / HyperCoag - DVT prophy / SS anemia - avoid hypoxia, hypovolemia, hypothermia

33
Q

Family Hx w/ Anesthesia

A

MH - halothane contracture test = avoid all triggers
Atypical PseudoChol - dibucaine test = avoid succs and ester metab Rxs (esmolol, local anes “esters”
PONV & Awareness

34
Q

Medication History

A

ETOH = enzyme induced, incr/decr Rx and Anesthetic effect / BB = bradys, decr BP, depr SNS / Abx = prolong NMB / ACE-inh/ARBs = excess hypotension / Benzos/Narc = anesthetic tolerance / Diuretics = hypovolemia and lyte abnls (K) / MAOIs - no demeral/pressore –> HTN crisis, TCA - no pressors –> HTN crisis (SSRIs all OK)

35
Q

Medication History

A

Herbals stopped x2 weeks / diuretics, anti-plates, anti-coag are held, hypoglycemic agents held/reduced / cont most others

36
Q

Allergy History

A

Known allergies: latex, dyes, foods. Food allergy of avocado & banana = latex allergy. *allergy not = to intolerance. Nature of allergic reaction

37
Q

Pre-Op Medicaitons/effects

A

anxiolysis/amnesia = versed / analgesia = fentanyl / increase gastric pH = ranitidine/famotidine, bicitra / decr gastric volume = metoclopramide / antisialogogue = glycopyrrolate

38
Q

Components of Physical Exam

A

airway and denitition / vitals signs / weight / auscultate heart/lungs / skin jaundice/edema / spine for neuraxial block –> ASA physical status at end of eval

39
Q

ASA status classification

A

Class 1 - healthy, no medical issues / Class 2 - mild systemic disease (all prego, chronic meds, no fxnl limits) / Class 3 - severe systemic disease, non incapacitating (DM w/ PVD, limiting Pulmo disease) Class 4 - severe systemic disease constant threat to life (acute CHF, unstable angina) / Class 5 - no life >24 hours / Class 6 - brain dead, harvest // add E to class for emergency surgery

40
Q

Anesthetic Plan Goals

A

high pt satisfaction and safety, excellent operating conditions, rapid recovery, inexpensive, minimize post op effects

41
Q

Types of Anesthetic Techniques

A

general, neuraxial, peripheral nerve block, local anesthesia + MAC

42
Q

Determinants of Choice of technique

A

Party preference, co-existing disease, surgical site, intraop positioning, full stomach (regional)/fasted, condition of airway, elective vs emergency, clinical setting

43
Q

Variations w/i each technique: General

A

General: IV vs inhalation, induction routine vs rapid sequence, choice of specific agents // AW mgmt, ETT vs LMA vs Mask, balanced vs single agent, muscle relaxants depends on surgical field

44
Q

Variations w/i each technique: Neuraxial & Peripheral block

A

SAB vs CLE: SAB simpler to perform, rapid onset, reliably dense, great for sacral // CLE less dramatic HD effects, can re-dose intraop and postop // localized effect for sicker patient, but req coop patient, technically more diff, risk of IV injection

Preanesthesia Evaluation (2 decks)

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