Preop

Question 0

Goldmans index of cardiac risk – takes what into account?

Answer 0

Heart - JVD, recent MI, PVCs/rhythm abnormalities, valvular disease

Other - old age, prior medical condition

Question 1

Ejection fraction that prohibits noncardiac operations? Why?

Answer 1

35%; 75-85% chance of perioperative MI (55-90% mortality)

Question 2

Worst finding regarding preoperative cardiac risk? Treat with what prior to surgery?

Answer 2

JVD;

ACE inhibitors, beta blockers, digitalis, and diuretics before surgery

Question 3

Second-worst finding regarding preoperative cardiac risk? Mortality?

Answer 3

Recent transmural or subendocardial MI

If within three months, mortality is 40%
After six months, mortality 6%

Question 4

Ventilation versus oxygenation – which is problematic for surgery in a smoker?

Answer 4

Compromised ventilation (high CO2, low FEV1)

Question 5

If a smoker needs an elective surgery – recommendation?

Answer 5

Cessation of smoking for eight weeks and intensive respiratory therapy (PT, the expectorants, incentive spirometry, humidified air)

Question 6

Patient with liver dysfunction – predictors of mortality? Mortality rates?

Answer 6

Billirubin, albumin, PT, encephalopathy, ascites (Child’s score criteria)

40% if Billirubin over two, albumin below three, PT over 16, encephalopathy

80% mortality if Billirubin over four, albumin level III, blood ammonia over 150, (or three of the 40% mortality indicators)

Question 7

Definition of severe nutritional depletion?

Answer 7

#Loss of 20% body weight over a few months
#serum albumin below three
#anergy to skin antigens
#serum transferrin less than 200

Question 8

Absolute metabolic contraindication to surgery?

Answer 8

diabetic coma