preop evaluation (Mod 5) Flashcards
Know the American Society of Anesthesiologist physical status system (ASA PT) table
Adding E denotes an emergency
have to be able to classify MET score, but don’t have to calculate it (slide 16)
What is the purpose of the pre operative assessment?
To identify medical conditions that may adversely affected by the administration of anesthetic meds
What part of the med history especially noted from a patient history?
symptoms and diseases related to cardiovascular, respiratory, and neuromuscular systems bc they directly influence the anesthetic
What is Functional Capacity?
A predictor of post op cardiopulmonary or neurocognitive complications
What is defined as a poor exercise tolerance?
</= 4 METS
What is exercise capacity measured by?
Metabolic equivalents (MET)
- 1 MET = Consumption of 3.5 ml oxygen/kg/min of body weight
How much is 1 MET equivalent to?
1 met = consumption of 3.5 ml oxygen/kg/min of body weight
American Society of Anesthesiologists Physical Status (ASA PS) 1?
A fit and healthy patient (healthy, nonsmoking, exercise daily)
American Society of Anesthesiologists Physical Status (ASA PS) 2?
A pt with mild systemic illness
- Mild disease without substantive functional limitations
- Current smoker, obesity, well controlled DM/HTN, mild lung disease, milkd lung disease
American Society of Anesthesiologists Physical Status (ASA PS) 3
A pt with severe systemic disease, substantive functional limitations.
- one or more moderate to severe diseases
- i.e uncontrolled HTN, DM with vascular issues, pervious MI, COPD, Reduced EF
American Society of Anesthesiologists Physical Status (ASA PS) 4
A pt with severe, systemic disease that is a constant threat to life
- CHF, Renal or hepatic failure, unstable angina
American Society of Anesthesiologists Physical Status (ASA PS) 5
Moribund pt who is expected to die without surgery
- Ruptured AAA, PTE, Increased ICP, multi organ failure
American Society of Anesthesiologists Physical Status (ASA PS) 6
Brain dead
What is a good predicator of post op cardiopulmonary or neurocognitive complications?
Functional capacity (or incapacity)
Which patients are most at risk throughout the perioperative period?
Those who had a recent MI and those with unstable angina
- Any Coronary Artery Disease (CAD) really
Levels of Canadian Cardiovascular Society (CCS) Classification of Angina?
4, with decreasing level of activity with risk of causing severity
CCS Functional Classification of Angina: Class 1?
CCS Functional Classification of Angina: Class 2?
CCS Functional Classification of Angina: Class 3?
CCS Functional Classification of Angina: Class 4?
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification?
4 classes that assess discomfort with physical activities that shows general signs of SOB and fatigue that would point towards CHF
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 1
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 2
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 3
The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 4
what would increase the risk of adverse affect for surgery from the respiratory system side?
- Reword
- severe systemic infection or Pneumonia
- Upper resp tract infections or hyperactive airways may require several weeks to normalize before assessment
What affect does smoking have on the respiratory system
- Increases risk of hypertension, tension, and PVD
- Decreases clearance of pulmonary secretions
- promotes bronchitis and exacerbates asthma…leading to development of COPD
- Increases risk of hypoxemia and impairs wound healing and the immune response
What would improve the outcome for smokers periopertvly?
- Quantify smoking history (pack years)
- Initiation cessation program 4-8 weeks prior to surgery
- At the min, cease smoking for a min of 12-24 hrs prior to help reduce delirious effects of smoking
What perioperative respiratory complications are COPD pts most at risk of
- Respiratory depression
- Atelectasis
- Retained secretions
- Pneumonia
- Respiratory insufficiency or failure
Preoperative care of COPD patients?
- Smoking cessation
- Avoidance of bronchospasm via preop bronchodilation via SABAs (also for asthmatics)
- Treatment of AECOPD (antibiotics)
What is typically performed prior to extensive surgery and why?
Spirometers and ABGs
- Resp function deteriotates following upper abdominal or thoracic surgery
- Lung detox ration will increase the risk of post op resp complications
Assessment of patients at risk for CHF?
Inquire s&s of fatigue:
- syncope
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea (PND)
- and cough
And refer to the NYHA classifcation of heart failure
