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Anesthesia Techniques > Preop > Flashcards

Preop Flashcards

1
Q

what is a significant predictor of cardiac risk

A

exercise intolerance

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2
Q

how should a dm patient dose their oral meds vs insulin preoperatively

A

hold oral dm meds
adjust insulin doses

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3
Q

predictors of ponv

A

female
history of ponv/motion sickness
nonsmoking
<50 years old
general anesthesia
volatiles and nitrous oxide
postop opioids
duration of anesthesia
surgery type: chole, laparscopic, gynecologic

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4
Q

name some herbs that can cause increased bleeding

A

feverfew
garlic
ginger
ginkgo
ginseng
vitamin E

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5
Q

t or f- by itself, the Mallampati classification has a high positive predictive value in identifying patients who are difficult to intubate

A

false
low positive

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6
Q

what can be seen on each grade on the Mallampati scale

A

1- soft palate, uvula, tonsillar pillars
2- soft palate, upper uvula
3-soft palate
4- hard palate only

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7
Q

list other identifiers of difficult tracheal intubation

A

-long upper incisors
-prominent overbite
-inability to protrude mandibular incisors anterior to maxillary incisors
-uvula not visible when tongue protruded while pt sitting
-shape of palate highly arched or narrow
-mandibular space non compliant
-tmd < 3 fingers
-neck short/thick
-limited rom of neck/head

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8
Q

what heart problems should specifically be auscultated for during cv system preop examination

A

aortic stenosis
abnormal rhythms
gallops suggestive of Heart failure

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9
Q

how does an aortic stenosis murmur sound on auscultation

A

murmur radiating to the carotids

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10
Q

what further workup is needed if bruits are heard over the carotid arteries

A

determine risk of stroke

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11
Q

what are the categories of MACE (major adverse cardiace events)

A

low risk procedure= < 1% incidence of MACE
High risk= >1% risk of MACE

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12
Q

Which ASA PS class is a normal healthy patient, no organic, physiologic, biochemical, or psychiatric disturbance

A

ASA 1

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13
Q

Which ASA PS class is mild to moderate systemic disease that is well controlled and causes no organ dysfunction or functional limitation

A

ASA 2

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14
Q

Which ASA PS class is treated hypertension

A

ASA 2

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15
Q

Which ASA PS class is severe systemic disease of at least one organ system that does cause functional limitation

A

ASA 3

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16
Q

Which ASA PS class is stable angina

A

ASA 3

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17
Q

Which ASA PS class is severe systemic end stage disease of at least 1 organ system that is life threatening with or without surgery

A

ASA 4

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18
Q

Which ASA PS class is congestive heart failure

A

ASA 4

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19
Q

Which ASA PS class is renal failure

A

ASA 4

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20
Q

Which ASA PS class is a moribund patient who has little chance of survival but is submitted to surgery as a lest resort

A

ASA 5

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21
Q

Which ASA PS class is a ruptured aortic aneurysm

A

ASA 5

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22
Q

Which ASA PS class is resuscitative effort

A

ASA 5

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23
Q

Which ASA PS class is a declared brain dead patient whose organs are being removed for donor purposes

A

ASA 6

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24
Q

The preoperative evaluation of the patient with known or suspected cardiovascular disease is focused on what two areas

A
  1. identify clinical risk
  2. preoperative cardiac testing
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25
Q

what are clinical s/s of heart failure

A

dyspnea
limited exercise tolerance
orthopnea
jvd
crackles
third heart sound
peripheral edema
ef < 30%

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26
Q

in heart failure patient, what 2 symptoms should be optimized before elective surgery

A

ventricular function
pulmonary edema

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27
Q

patients with moderate to severe valvular stenosis or regurg should have an echo within __ year(s) of surgery

A

1

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28
Q

why should an ekg be done preoperatively on every dm patient

A

high risk for silent MI- look for Q waves

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29
Q

when should bp be treated for those over 60 vs those younger than 60

A

> 60= 150/90
<60- 140/90

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30
Q

what processes are involved in metabolic syndrome- 4

A

htn
atherogenic dyslipidemia
high fasting glucose
central obesity

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31
Q

what is atherogenic dyslipidemia

A

high triglyceride
low HDL

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32
Q

what are examples of 1 MET

A

daily self care
walk indoors around house
walk a block
light work around house

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33
Q

what are examples of 4 MET

A

climb a flight of stairs
heavy work around house
golf, bowling, throw football

34
Q

what is highly suggestive of past MI in high risk patients on an EKG

A

abormal q waves

35
Q

what is considered a positive pharmacologic stress test ECG

A

severe regional wall motion abnoramlities

36
Q

what types of patient should have stress testing before surgery

A

unstable angina
chf
significant dysrhythmias
severe valvular disease

37
Q

how long should noncardiac elective surgery be delayed after the following stents:
-coronary ballon angioplasty
-bare metal
-drug eluting

A

-coronary ballon angioplasty= 14 days
-bare metal= 30 days
-drug eluting= 6-12 months

38
Q

how long does a person need to stop smoking to reduce ther ate of postop pulmonary complications

A

4-8 weeks

39
Q

what can you give a patient with severe asthma for prophylaxis against pulmonary complications

A

steroids

40
Q

stopbang

A

S-Snoring
T-Tired during the day
O-Observed apnea
P -pressure- htn
B- BMI>35
A-age>50
N-neck circum: M > 17 in, F >16 in
G-gender male

41
Q

what is the leading cause of renal failure requiring dialysis

A

DM

42
Q

what type of cells are destroyed in pancreas of those with type 1 diabetes

A

beta cells

43
Q

which type of diabetes is dka more common

A

type 1

44
Q

what is hgb A1c goal for type 1 vs type 2 dm

A

1- <7.5%
2- < 7%

45
Q

what are the 4 sx of the classic clinical presentation of a patient with pheochromocytoma

A

intermittent htn
headache
diaphoresis
tachycardia

46
Q

what syndrome is a potential disorder in patients on long term corticosteroids

A

cushing syndrome

47
Q

what are s/s of cushing syndrome

A

skin striations
truncal obesity
htn
hypovolemia
easy brusing

48
Q

your patient on long term steroids has hotn that isn’t responding to fluid or vasopressors. What could you try

A

steroid

49
Q

how does liver disease affect iv drugs

A

decreased plasma protein production= affects drug binding, volume of distribution, metabolism, clearance

50
Q

what are considered clear liquids

A

water
fruit juice without pulp
carbonated beverages
clear tea
black coffee

51
Q

what is the minimum fasting period in hours for the following:
clear liquids
breast milk
infant formula
nonhuman milk
light meal

A

clear liquids- 2 h
breast milk- 4 h
infant formula- 6 h
nonhuman milk- 6 h
light meal- 6 h
fried meal- > 8h

52
Q

which has the longest serum half life: cimetidine, ranitidine, famotidine

A

famotidine

53
Q

what is the moa of metoclopramide

A

dopamine antagonist
stimulates upper gi motility, increase GE sphincter tone, relaxes pylorus and duodenum thereby reducing gastric volume

54
Q

what can occur with the rapid administration of reglan

A

abdominal cramping

55
Q

t or f- regland is recommended in those with bowel obstruction

A

false

56
Q

reglan is recommended for which type of patients

A

obese
parturients
emergency surgery
trauma
dm with gastroparesis

57
Q

where do benzodiazepines work

A

gaba receptor in cns

58
Q

which is more potent, diazepam or midazolam

A

midazolam: 2-3x

59
Q

what heart problem can fentanyl cause

A

bradycardia

60
Q

t or f- fentanyl causes myocardial depression

A

false

61
Q

which anticholinergic produces more sedation or amensia

A

scopolamine- tertiary amine

62
Q

which anticholinergic produces the most increase in heart rate

A

atropine

63
Q

how do anticholinergic drugs produce vagolytic action

A

blocks acetylcholine at the heart

64
Q

how can central anticholinergic syndrome be treated

A

physostigmine

65
Q

what are s/s of central anticholinergic syndrome

A

confusion
restlessness
obtundation
delerium

66
Q

administration of anticholinergic drugs does what to the bodies heat response

A

decreases sweating, increases body temp

67
Q

why are cephalosporins the most popular abx

A

cover common skin microbes

68
Q

vancomycin should be given ___ hours prior to incision

A

2

69
Q

medical malpractice refers to the legal concept of professional ________________

A

negligence

70
Q

the most common anesthesia lawsuits are for what 4 issues (excluding dental injuries)

A

death
brain damage
nerve damage
airway injury

71
Q

what are three eye injury complications that can be blamed on anesthesia

A

corneal abrasion
ischemic optic neuropathy
central retinal artery occlusion

72
Q

what are 3 risk factors of ischemic optic neuropathy after spinal fusion

A

wilson bed frame
obesity
long anesthetic duration

73
Q

what is the most common injury leading to anesthesia malpractice clames

A

damage to teeth or dentures

74
Q

how are dental injury complaints usually resolved

A

hospital risk management department

75
Q

what are the 3 key factors in the prevention of patient injury

A

vigilance
adequate monitoring
up to date knowledge

76
Q

what are the principal causes of death due during anesthesia related to

A

ventilation/oxygenation

77
Q

t or f- parents of a minor child can legally prevent that child from receiving blood

A

false

78
Q

what 4 things need to be proven by a patient/plaintiff to be successful in a malpractice lawsuit

A
  1. duty- crna owed patient a duty
  2. breach of duty- crna failed to fulfil duty
  3. causation- reasonable causal relation
  4. damages- damages resulted from breach of standard of care
79
Q

what is the term for professional negligence aka professional misconduct

A

malpractice

80
Q

what is the duty of the crna for the patient

A

adhere to standard of care for the treatment of patient

81
Q

what are the two tests to establish causation and therefore proximate cause

A

but for test- if injury would not have occurred but for the action of crna
substantial factor test- crna action was substantial factor in injury

82
Q

what is the difference between standards and guidelines

A

guidelines should be adhered to
standards must be adhered to

Anesthesia Techniques (11 decks)

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