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Preop Flashcards

1
Q

What is the main purpose of preoperative evaluation for elective surgical procedures?

A

To assess how much risk a certain patient has for the contemplated anesthetic and surgical procedure

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2
Q

Who is responsible for the preoperative evaluation of pediatric patients?

A

Primary care physician (pediatrician), surgeon, and anesthesiologist

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3
Q

What is the target population for preoperative evaluations?

A

Pediatric patients scheduled for elective surgery, invasive diagnostic and minor surgical/dental procedures in the ambulatory setting

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4
Q

What are the identified risk factors associated with perioperative adverse events?

A
  • Age: infants younger than 1 year old
  • History of prematurity
  • History of reactive airway disease
  • ASA physical class higher than 2
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5
Q

What age group is associated with a higher frequency of respiratory complications during surgery?

A

Infants younger than 1 year

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6
Q

What is a common respiratory complication in infants during anesthesia?

A

Irritation of the airway (laryngeal stridor/spasm) and irregular breathing patterns

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7
Q

What is the ASA classification for a normally healthy patient?

A

Class I

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8
Q

What is the ASA classification for a patient with severe systemic disease that is a constant threat to life?

A

Class IV

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9
Q

What is the recommended waiting period for elective surgery after an asthma attack?

A

4-6 weeks

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10
Q

What factors should be considered when managing a child with a recent upper respiratory tract infection (URI)?

A
  • Urgency of the procedure
  • Likelihood that symptoms are due to an infectious etiology
  • Severity of symptoms
  • Planned mode of anesthesia administration
  • Potential risk factors for respiratory complications
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11
Q

What should a preoperative medical history include?

A
  • History of present illness and indication for surgical procedure
  • Past medical history and complete review of systems
  • Allergies
  • Medications
  • Surgical and anesthesia history
  • Family history
  • Functional status
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12
Q

What components of the physical examination should be emphasized?

A
  • Weight and height
  • Vital signs (blood pressure, pulse, respiratory rate)
  • Cardiac and pulmonary examination
  • Airway examination
  • Other pertinent exam
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13
Q

True or False: All infants younger than 1 year with a cardiac murmur should undergo formal evaluation by a cardiologist before surgery.

A

True

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14
Q

What are the critical information frequently omitted in pediatric preanesthetic history?

A
  • Weight
  • Blood pressure
  • Room-air oxygen saturation
  • Allergies
  • Cardiac murmur history
  • Previous subspecialty encounters
  • Medications
  • Extent of neuromuscular disease
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15
Q

Fill in the blank: The presence of _______ in children increases the risk of airway complications.

A

upper respiratory tract infection

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16
Q

What is the relationship between ASA physical status and anesthetic risk?

A

Anesthetic risk increases markedly with ASA score and co-existing diseases

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17
Q

What is a common complication for former preterm infants post-anesthesia?

A

Postoperative apnea

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18
Q

What should be included in a functional status assessment during preoperative evaluation?

A

Assessment of the patient’s daily activities and limitations due to health conditions

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19
Q

What is the significance of identifying occult cardiac lesions before surgery?

A

They may have hemodynamic consequences during surgery

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20
Q

What are the two common concerns with former preterm infants regarding anesthesia?

A
  • Bronchopulmonary dysplasia
  • Possibility of postoperative apnea
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21
Q

What is the recommendation for patients with a history of reactive airway disease prior to surgery?

A

Asthma must be controlled and the child should be well

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22
Q

What is the recommended action if a child has a cardiac murmur?

A

Identify occult cardiac lesions that may have hemodynamic consequences

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23
Q

What are some factors that increase the risk of postoperative apnea in former preterm infants?

A
  • Anemia (hemoglobin < 30%)
  • Apnea at home
  • Postconceptional age
  • Gestational age
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24
Q

What should be done for a child with a recent viral infection before surgery?

A

Careful consideration of postponing surgery based on respiratory history and current symptoms

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25
What is the effect of a recent upper respiratory tract infection on surgery risk?
Increases risk of respiratory complications, particularly in children with a history of reactive airway disease
26
What is the primary conclusion regarding routine laboratory examinations for preoperative evaluation?
There are NO routine laboratory examinations needed for preoperative evaluation. ## Footnote Laboratory testing should be selective and justified by specific findings on the history and physical examination.
27
What are the potential medical reasons for ordering preoperative tests?
* To detect unsuspected but not modifiable conditions * To detect conditions where interventions may lower surgery risk * To obtain baseline results helpful in decision making * Screening for unrelated conditions * Satisfying institutional criteria * Habit ## Footnote These reasons emphasize the importance of individualized assessment rather than blanket testing.
28
What did a study of 2000 patients undergoing elective surgery reveal about routine preoperative tests?
60% of routinely ordered tests would not have been performed if testing had only been done for recognizable indications. ## Footnote Only 0.22% of these revealed abnormalities that might influence perioperative management.
29
What is the recommendation regarding routine complete blood counts?
Routine complete blood counts are NOT recommended. ## Footnote Hemoglobin determination should be considered in specific populations such as infants less than one year old and adolescent menstruating females.
30
In which situations should coagulation tests be considered?
* Children with clinical history suggestive of hemostasis problems * Children undergoing procedures with increased bleeding risk * Patients on anticoagulants or needing anticoagulation post-operatively ## Footnote Unexpected abnormalities of PT or PTT are uncommon and often do not alter preoperative management.
31
What is the recommendation regarding routine electrolyte determination?
Routine electrolyte determination is NOT recommended unless there is a history increasing the likelihood of an abnormality. ## Footnote Electrolyte abnormalities are rare in healthy children.
32
When are chest radiographs recommended for pediatric patients?
Chest radiographs may be requested in children with cardio-respiratory signs and symptoms. ## Footnote Routine chest x-rays are not recommended as they add little to clinical evaluation.
33
What does the evidence suggest about routine urinalysis in preoperative evaluation?
Routine urinalysis is NOT recommended and adds little to the preoperative evaluation of a healthy child. ## Footnote More than 80% of abnormal UA results were known, clinically insignificant, or false-positives.
34
What is the significance of preoperative pulmonary function tests?
Pulmonary function tests may be done for patients who will undergo thoracic surgery. ## Footnote This is to assess the patient's respiratory capacity and potential risks.
35
What is the relationship between abnormal test results and the risk of perioperative hemorrhage?
The relationship is not well defined but appears to be low, particularly in patients deemed to have a low risk based on history and physical examination. ## Footnote Routine preoperative hemostatic screening tests should not be performed routinely.
36
What is the recommendation from the American Academy of Pediatrics regarding laboratory testing?
Laboratory testing should be considered in patients with a history or medical condition suggesting a possible hemostatic defect. ## Footnote This includes patients undergoing surgical procedures that might induce hemostatic disturbances.
37
What does the data indicate about routine urinalysis in healthy children before surgery?
Routine UA adds little to the preoperative evaluation and should be omitted ## Footnote Screening urinalysis has failed to discover serious underlying problems in most children studied.
38
When should pulmonary function tests (PFTs) be performed?
For patients undergoing thoracic surgery or with unexplained pulmonary symptoms ## Footnote Routine PFTs are not indicated for healthy patients prior to surgery.
39
What clinical findings are more predictive of pulmonary complications than spirometric results?
Decreased breath sounds, prolonged expiratory phase, rales, rhonchi, or wheezes ## Footnote FEV1, FVC, and FEV1/FVC were nearly identical among patients with or without complications.
40
In which scenarios is an ECG recommended for children?
Children with obstructive sleep apnea, bronchopulmonary dysplasia, congenital heart disease, or severe scoliosis ## Footnote Also for children with murmur or arrhythmia.
41
What does the NICE guideline say about the value of routine ECG in preoperative evaluation?
The value is unknown, but may increase with age and ASA grade ## Footnote Asymptomatic patients undergoing low-risk procedures do not benefit from routine ECG.
42
When should pregnancy testing be conducted preoperatively?
In menarche adolescents with unreliable history or those who admit pregnancy is possible ## Footnote The incidence of positive pregnancy tests among adolescents is low.
43
What is the duration of validity for laboratory examinations in preoperative evaluation?
Test results normal within the past four months can be used, barring changes in clinical status ## Footnote Less than 2% of test results conducted 4 months prior changed at the clinical evaluation.
44
What indicators signify malnutrition and increased perioperative risk?
* Weight loss * Serum albumin < 3.2 mg/dL * Total lymphocyte count < 3,000 per μL3 ## Footnote Malnourished patients experience increased surgical morbidity and mortality.
45
What are the recommended forms of preoperative nutritional supplementation?
* Oral supplementation * Enteral tube feeding * Parenteral nutrition ## Footnote Enteral tube feeding is underused and less expensive than parenteral nutrition.
46
What is the advised duration of preoperative nutritional supplementation for malnourished patients?
A minimum of seven to 15 days ## Footnote This duration is suggested to provide benefit in malnourished patients.
47
How should patients with seizure disorder be assessed for elective surgery?
Patients under optimal control can be assessed as low risk ## Footnote Anticonvulsants should be administered on schedule unless contraindicated.
48
What factors should be recorded for patients with seizure disorder?
* Type of seizures * Medication * Frequency of seizures ## Footnote This information is crucial for assessing surgical risk.
49
What is the risk classification for patients with seizure disorder under optimal control?
Low risk
50
When should anticonvulsants be administered before surgery?
On schedule or nearly so, 1 to 2 hours before surgery
51
What should be recorded regarding a child's seizure disorder?
Type of seizures, medication, frequency of seizures, and time under optimal control
52
What ASA classes are considered low operative-risk?
ASA classes I and II
53
What ASA classes classify children as high operative-risk?
ASA classes III and IV, children with special needs, and those with anatomic airway abnormalities
54
What factors must be considered in the decision to administer an anesthetic?
Risk, benefit, and consequence
55
Who is responsible for the final decision to cancel or proceed with surgery?
The surgeon and anesthesiologist
56
True or False: Patients with significant preexisting lung disease are expected to have a lower ASA class.
False
57
What is essential for the final medical analysis and recommendation regarding surgery?
Good clinical judgment
58
Fill in the blank: Patients classified as high operative-risk require further evaluation by a _______.
Specialist
59
What type of information is helpful for the anesthesiologist regarding peri-operative seizure medication management?
Suggestions regarding medication management
60
What is the purpose of the basic health assessment in preoperative evaluation?
To determine surgical/anesthesia risk
61
What clinical history should be individualized when considering surgery?
Type of surgery and diagnostic tests needed

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