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Health Assessment Oral > Preop Assessment > Flashcards

Preop Assessment Flashcards

1
Q

What are some components of the preop exam?

A
  1. o Pts med hx
  2. o Physical
  3. o Meds/allergies
  4. o ASA status
  5. o Airway assessment
  6. o Explanation of anesthetic plan.
  7. o Documentation
  8. o Consent
  9. o NPO status
  10. o Lab testing/diagnostic
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2
Q

What can you obtain from chart review of the patient?

A

o Demographics

o Dx/sx

o Sx Consent

o Prior H&P

o Nursing notes

o Pts questionnaire

o Results of tests

o EKG/PFT/Xray

o Vitals

o Med list

o Allergies

o OLD ANESTHESIA RECORDS → any complications noted?

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3
Q

What are some medications to d/c prior to sx?

A

o ACEI- prils

o ARBs – sartans

o Metformin

o Regular Insulin- morning of

§ unless on continuous pump

§ DM 2- none or up to ½ of long acting insulin. D/C short acting

§ DM 1- small amount (1/3) long acting morning of sx

o NSAIDs- 48 hrs

o Aspirin – 7 days

o Warfarin – 5 days

o Clopidogrel- 5 days

o Sildenafil – 48 hrs

o Viagra- 24 hrs

o Topical medications

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4
Q

Who requires early preoperative assesment? When is the ideal time to have that assessment?

A

1 weeks prior to sx

— CV: Angina, CHF, MI, CAD, poorly controlled HTN

— Pulm: COPD/severe asthma, airway abnormalities, home O2 or ventilation

— Endocrine: IDDM, adrenal disease, active thyroid disease

— GI/GU: Liver disease, end-stage renal disease

— Metabolic: Morbid obesity, symptomatic GERD

— CNS: Severe kyphosis, spinal cord injury

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5
Q

What are some components of preop interview?

A
  • — Introduction
  • — Confirmation- pt ID, dx, procedure (site)
  • — Education- type of anesthetic, IV insert, urinary cath, airway instrumentation, monitors, post op care
  • — Establishment
    • — Open ended questions, general to specific, organized, systematic, individualized, lament terms, controlled environment (+/- family members), interpreters, unrushed
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6
Q

What are some components of an airway assessment?

A
  • Mallampati Classification: PUSH
  • Thyromental distance
    • 3fb (6 cm)
      • >9 cm–> harder to intubate
  • Interincisor distance: 2 fb (3 cm)
  • Atlanto-occipital function: extension
    • Normal: 35 degrees
    • Problem: < 23 degrees
  • Mandibular protrusion test:
  • Hyomental distance
    • ~ 2 fb
  • Neck circumference
    • normal neck:
      • Male: 15-16 inches
      • Female: 13-14 inches
    • > 17 inches (40 cm) → difficult airway (5% chance of difficult area; q cm increased, increase by 1.3%)
    • big neck: harder
  • Prayer sign: collagen linking disorder → concern w/ neck extension
    • Knuckle touch (DM pts)

From table

  • touch chin to chest
  • highly arched palate
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7
Q

What is the predictive value of a test?

A

— SNout – Sensitivity rules OUT→ true negative

— SPin- Specificity rules IN

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8
Q

When should you get a CXR?

A

— Assessment of periop risk

— Decision: based on abnormalities

— Active things happening: SOB, intercostal retractions, deviated trachea, active wheezing, rust colored sputum

— Chronic things: Severe COPD, pulm edema, pneumonia, suspected mediastinal masses (deviated trachea)

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9
Q

Recommendations for preop 12 lead EKG?

A

— IIa: reasonable to perform 12-lead → IHD. Significant arrhythmia, PAD, CVD. Significant structural HD (unless low risk procedure)

— IIb: Considered 12-lead → asymptomatic pts w/o known coronary heart disease, (except low risk sx)

— III: NOT BE PERFORMED → not helpful for asymptomatic pts undergoing low risk procedure

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10
Q

Current recommnedations for NPO status?

A

o Based on CURRENT ASA guidelines that balance risk factors of fasting with pulmonary aspiration risk

  • 2 hours→ clear liquids all patients (Apple juice, Gatorade, no creamer/sugars)
  • 4 hours→ breast milk
  • 6 hours → formula or solids; light meal
  • 8 hours→ heavy meal fried or fatty food
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11
Q

Which patients are prone to aspiration?

A

— Age extreme < 1/ > 70 yo

— Ascites

— Collagen vascular dx, metabolic disorders (DM, obesity, EDRD, hypothyroid)

— HIV- from lipid distribution to neck and abdomen

— Hiatal hernia

— Esophageal sx

— Mechanical obstruction (pyloric stenosis)

— Prematurity

— Pregnancy

— Neuro disorders

— Anyone eaten food/nonclear drinks

— Trauma

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12
Q

What is an ASA status and how do you determine ASA status on your patient?

A
  • ASA is “to classify the physical condition of the patient requiring anesthesia and surgery”
    • ASA is independent of the operative procedure and surgical risk
      • focuses mainly on patient’s health
    • SUBJECTIVE communication tool used between anesthesia providers

ASA classes:

  • — I: normal, no systemic dx
  • — II: mild systemic disease, well controlled, no fx limitations
    • — Ex: DM w/ controlled BG
  • — III: severe systemic disease w/ functional limitations
    • — MI > 3 mo ago
  • — IV: severe systemic disease that is CONSTANT threat to life
    • — MI < 3 mo ago
  • — V: moribund pts, not expected to survive with/without the surgical procedure
    • — Ex: ruptured aortic aneurysm
  • — VI: declared brain dead whose organs are being harvested for donation
  • — E: emergency operation required
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13
Q

How do you determine appropriate fluid requirements intraop?

A
  • MIVF: 4:2:1
  • Fluid deficit: NPO x MIVF → divide by 3 → ½ in 1st hr, ¼ 2nd and 3rd hr
  • Allowable blood loss: EBL x starting Hct – allowable Hct/ pts Hct
    • 3rd space:
      • Started in 2nd hr
        • Superficial: 1-2 ml/kg
        • Minimum: 2-4 ml/kg
        • Moderate: 4-6 ml/kg
        • Severe: 6-8 ml/kg
  • Blood replacement: start in 2nd hr
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14
Q

What conists of appropraite informed consent for the patient?

A
  • Explanation of planned anesthetic
  • Explanation of options available
  • R/B
  • Pts cooperation
  • w/o consent→ ASSULT AND BATTERY
  • peds → need guardians
  • need witness and pt’s signature
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15
Q

What are predictors for difficult larngoscopy?

A
  • Reports hx of difficult intubation, aspiration pna after intubation, dental or oral truama
  • OSA or snoring
  • previous head/neck radiation
  • congenital dx IE down syndrome
  • inflamamtory/arthritic dx- RA, anklyosign spondylitis, scleroderma
  • obesit, cervical spine dx or previous sx
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16
Q

Predictors of a difficult mask ventiatlion?

A
  • Age >55 years
  • OSA/snoring
  • previous head/neck radiation, sx, truama
  • lack of teeth
  • beard
  • BMI >26 kg/m2
17
Q

What are AANA standards of care for preop asessment?

A
  • Plan of anesthesia care
    • Address pt concerns, formulate pt specific plan
  • Informed consent for anesthesia care and related services
  • Documentation
  • Equipment
    • Verify function prior to each anesthetic
    • Adhere to manufactrer’s operating instructions and other safety precaution to complete a daily anesthesia equipment check
18
Q

How do we determine which preop testing is needed? What is the benefit to selective testing?

A

The 2012 ASA practice advisory for preanesthia evaluation States that routine preop tests do not make an important contribution to preanesthetic evaluation of an symptomatic patient

  • Preop testing should be slectively ordered based on:
    • Pt medical hx and physical exam
    • Planned sx
    • Expected intraop blood loss
  • Selective testing
    • Expedites pt care
    • Reduces healthcare cost
    • Improves delivery of periop meds

Health Assessment Oral (12 decks)

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