Premed Rounds

Question 1

What is functional capacity

Answer 1

Measure of metabolic demands of various daily activities on the heart

Question 2

Functional capacity assessment

Answer 2

Poor (< 4 METS): unable to walk more than 2 blocks on level ground without stopping due to symptoms. affect eating, dressing, toileting, walking indoors, light housework

Moderate (4 to 7 METS): walking 4 mph cycling, climbing a flight of stairs, golf, yardwork

Excellent (>7 METS): squash, jogging 10 min mile, scrubbing floors

Question 3

Risk factors lead to morbidity and mortality in respiratory system

Answer 3

• poor lung function test
• age > 65
• obesity: decrease compliance and functional residual capacity
• smoking: stop > 8 weeks prior to op to gain benefit
• surgical factors: thoracic and upper abdominal surgery
• respiratory failure

Question 4

Effects of smoking

Answer 4

• increase airway reactivity
• increase mucus production
• increase risk of chest infection
• decrease ciliary mobility

Question 5

What to do if pt has URTI before op

Answer 5

• postpone elective surgery at least 2-3 weeks dt risk of post operative arterial desaturation

Question 6

Fasting guidelines

Answer 6

2 hrs: clear fluid (water, fruit juice without pulp, clear tea, black coffee)

4 hrs: breastmilk

6 hrs: infant formula, non human milk, light meal, heavy meal

Question 7

Patients who arent suitable for premed

Answer 7

• ill septic/elderly
• potential difficult airway
• daycare surgery
• most neuro patients
• neonates and infants less than 6 months

Question 8

Med for anxiolysis and when to give

Answer 8

Oral benzo (midazolam)

• given in elective patient
• given at night and before sending pt to OT

Question 9

Med for obstetric patient

Answer 9

• oral ranitidine (H2 receptor antagonist) 150mg ON & morning of op
• 0.3M sodium citrate 30ml
• Iv metoclopramide 10mg

Question 10

Aspiration prophylaxis

Answer 10

• H2 receptor antagonist ie ranitidine
• PPI ie omeprazole
• non particulate antacids ie 0.3M sodium citrate
• prokinetic agents ie: metoclopramide

Question 11

PONV prophylaxis

Answer 11

• metoclopramide
• ondansetron and granisetron

Question 12

Which med to continue and which med should discontinue

Answer 12

Continue
- anti HPT
- b blocker
- statins

Discontinue/replace
- aspirin
- anticoagulant
- diabetic medications
- MAOIs