Preop

Question 1

Preop prior to surgery

Answer 1

Daily activity limitation

Bad bp management
Scoliosis kyphosis with functional difficulty
Tmj 
Cervical thoracic spine
Chemotherapy
Obesity
Gerd or hiatal hernia
No diet controlled diabetes
Adrenal disorders

Question 2

ASA 1

Answer 2

Normal healthy patient

Question 3

Asa 2

Answer 3

Mild systemic disease no func limitations (HTN tobacco aged

Question 4

What meds do we stop 2 weeks before?

Answer 4

Generally stop all two weeks prior

Aspirin
Antiplatelet nsaids
Arthritis meds
Migraine
Pain meds
 Cox2 inhibitor
Diet meds
Herbal teas/supplements
Diet supplements

Question 5

Which cannot be stopped abruptly?

Answer 5

Ulcerative colitis
Psych medicine
MAO
Stop alcohol 48 hours
Stop tobacco 24 hours ( not 5 days by coughing)
Stop street drugs\ illicit (3days before)

Question 6

Anesthesia history

Answer 6

Hx (history: difficult airway, PONV nausea
Malignant Hypothermia ( highly aggressive increase in temperature)
Pseudocholinesterase deficiency
(keep on vent and sedated)

Question 7

Malignant Hyperthermia symptoms

Answer 7

Symptoms:
Hypercarbia 
Tachycardia
Tachypnea
Hyperthermia (late sign)
HTN
Cardiac dysrhythmias
Hypoxemia
Hyperkalemia
Skeletal muscle rigidity
Myoglobinuria

DNA TESTS!
Diagnostic tests for MH
Halothane-caffeine contracture test
Future – genetic testing of the ryanodine receptor

go to mhaus or call 800-644-9737

Question 8

“my aunt milly got a bad fever and died”

Answer 8

malignant hyperthermia

Question 9

How do you tell Pseuodocholinesterase Deficiency?

Answer 9

Dont come back from muscle relaxant

keep on the vent and sedation

Question 10

Do they have cardiac dysfunction?
History signs?
physical signs?
ECG?
Chest X ray?
cardiac testing?

Answer 10

History: MI, congestive heart failure, paroxysmal nocturnal disease, ankle swelling, DOE (dyspnea on exertion)

Physical exam: hypotension/tachycardia, neck veins prominent, rales( noisy lungs) pitting edema

Electrocardiogram: Ischemia/infarction, rhythm, or conduction abnormalities

Chest X-ray: Cardiomegaly, pulmonary vascular congestion/pulmonary edema, pleural effusion

Cardiac Testing: Cath data—LVEDP >18, EF <0.4, Cl <2.0 l/min–1/min–2Echocardiography—low EF, multiple regional wall motion abnormalities, hypokinesis, akinesis, or dyskinesia

Question 11

What percentage of the US are at risk for ischemic heart disease?
Risk factors?

Answer 11

1/3
>_ 45 female >_ 55 male
Family history
smoking
>140/90 or on antihypertensives

Question 12

Left ventricular ejection fraction

Answer 12

amount of blood that left ventricle expells with each contraction. less than 35% LVEF then twenty percent die.

Question 13

4D’s of Airway Evaluations

Answer 13

Dentition (count yo teef)
Distortion (
Disproportion (
Dysmobility ( cant open mouth)

Question 14

How is the airway

Answer 14

Cormack and Lehane laryngoscopy view
Grade I: full view of the cords
Grade II: partial view of the cords
Grade III: view of the epiglottis
Grade IV: No view of the cords or epiglottis

Question 15

Thyromental distance is ______ to the _____ . ____ many fingers are a good size?

Answer 15

thyroid notch (adams apple) to the jaw
3 fingers

Question 16

T/F Sniff position the whole surgery

Answer 16

False that would make sore especially if arthitic.

Question 17

biting upper lip is testing

Answer 17

protrusion of mandible. Tells if intubation will be easier

Question 18

Difficult mask ventilation

Answer 18

Obese (thick neck 
Bearded
Eldery 
Snorers
Endentulous

OBESE

Question 19

If on steroids prior and give ephedrine, then BP does go up. What do you do?

Answer 19

give steroids the ephedrine.

Question 20

carotid bruit

Answer 20

A carotid bruit is a vascular murmur sound (bruit) heard over the carotid artery area on auscultation during systole.