Preop Concerns Flashcards
What are the concerns with chronic hypertension?
Risk of perioperative hemodynamic instability
Shift of cerebral auto regulation curve to the right and thereby compromising cerebral perfusion pressure and making it more difficult to maintain cerebral perfusion while avoiding cardiac stress
End organ ischemia
What are the concerns with diabetes?
Hyper and hypoglycemia
Renal insufficiency
Autonomic neuropathy causing blood pressure lability
Neurological injury due to preexisting neuropathy
What are the concerns of TIA
Inadequate cerebral perfusion through circle of Willis
What are the concerns with chronic renal failure?
Electrolyte abnormalities Metabolic acidosis Volume status Cardiac conduction Hyperglycemia Uremic bleeding Altered drug clearance Increased risk for cardiac irritability due to electrolyte abnormalities
What are the concerns with pulmonary disease?
Bronchospasms PTX Hypoxia Postop ventilation Infection Impaired wound healing Difficult airway Right heart dysfunction and failure
What is a reasonable approach to management of preop HTN?
Delay any patient with SBP > 180 or DBP > 110
End organ ischemia
Undergoing cardiac, carotid, or pheochromocytoma resection
6-8 weeks to optimize
What do you want to know about a patient with CAD and stent?
Degree of CAD and which vessels are involved
What kind of stent and when
What meds is he on and compliance
Look at old records of imaging, stress test, hospital stays, interventions
Physical exam and history for Orthopnea, EKG changes, CP after stent placement? METS
What are the risk factors for late stent thrombosis?
Multiple lesions Lesions at bifurcations, small vessels, orifices Long or overlapping stent Suboptimal stent results Reduced LVEF Hypercoaguable state Advanced age MACE within 30 days of PCI Diabetes Renal failure
What is bridging therapy?
Continuing ASA and starting a short acting platelet inhibitor like eptifibitide 2-3 days before surgery (d/c 6h before surgery)
Heparin infusion
Why not just use a heparin infusion for bridging?
Because the heparin-antithrombin III complex’s ability to inactivate fibrin-bound thrombin and factor Xa is limited
