Preop II Flashcards
What are comorbidities defined as in the context of anesthesia risk?
Acute or chronic renal disease, insulin dependent diabetes, significant developmental delay to less than half age appropriate normal, and other co-morbid critical illness.
These conditions can increase the risk associated with anesthesia.
What constitutes a high-risk surgical procedure?
Vascular, thoracic, upper abdominal procedures with large expected fluid shifts, intraparenchymal neurosurgery, and spinal fusion.
These procedures are associated with greater complications and require careful assessment.
What is classified as high-risk in children with heart disease undergoing non-cardiac surgery?
Physiologically poorly compensated conditions, presence of major complications, and complex lesions such as single ventricle and cardiomyopathy.
These factors significantly influence the anesthesia management plan.
What are the ASA physical status classifications for high risk?
ASA physical status IV or V.
This classification indicates severe systemic disease that significantly increases anesthesia risk.
What is the recommendation for antibiotic prophylaxis prior to a procedure?
Indicated only for patients at high risk for developing infective endocarditis.
This includes those with prosthetic valves and previous episodes of infective endocarditis.
What are the guidelines for antibiotic prophylaxis according to the AHA?
High-risk patients undergoing high-risk procedures should receive prophylaxis.
This is to prevent infective endocarditis, especially in patients with specific heart conditions.
What is the preferred anesthetic for patients with muscular dystrophies?
Total IV anesthetics.
Inhalation anesthetics can cause complications such as rhabdomyolysis and hyperkalemia.
What are the preoperative considerations for children with cerebral palsy?
Assess disease severity, manage associated comorbidities like gastroesophageal reflux and epilepsy, and ensure adequate antibiotic coverage for aspiration pneumonia.
These considerations help mitigate risks during anesthesia.
What is the complication rate for general anesthesia in patients with cerebral palsy?
63.1% for perioperative adverse events.
Most complications are non-life-threatening, such as hypothermia and hypotension.
What medications decrease lower esophageal sphincter tone during anesthesia?
Propofol, volatile anesthetic agents, β-agonists, opioids, atropine, thiopental, tricyclics, glycopyrrolate.
These medications can increase the risk of aspiration.
What are the American Society of Anesthesiologists recommendations for pre-operative fasting?
Light meal or nonhuman milk up to 6 hours, clear liquids up to 2 hours before elective procedures.
Specific guidelines help reduce the risk of aspiration during anesthesia.
What is the impact of autism spectrum disorder on anesthesia management?
ASD patients may require different induction modes and have longer wake-up times compared to non-ASD patients.
Individualized approaches are necessary based on the patient’s level of cooperation.
What is the risk of aspiration associated with pre-existing conditions?
Gastrointestinal obstruction, previous esophageal surgery, hiatal hernia, obesity.
These conditions can significantly increase the risk during anesthesia.
Fill in the blank: Patients with __________ must have careful coordination and evaluation before surgery.
congenital heart disease.
Coordination among various subspecialists is critical for successful outcomes.
Is the presence of an upper respiratory tract infection an absolute contraindication to proceed with surgery?
No, it is not an absolute contraindication.
The decision should consider the risk-to-benefit ratio of the procedure.
How long may elective surgery be delayed after resolution of upper respiratory tract infection symptoms?
2–3 weeks.
This delay is recommended to reduce the risk of respiratory adverse events.
What are the respiratory adverse events associated with recent upper respiratory tract infections?
- Laryngospasm
- Bronchospasm
- Hypoxemia
These complications do not have long-term sequelae.
What is the COLDS Scoring Tool used for?
To predict perioperative respiratory adverse events in children with upper respiratory tract infections.
The COLDS score assesses risk factors for complications.
What does the acronym COLDS stand for?
- C: Current signs and symptoms
- O: Onset of symptoms
- L: Lung disease
- D: Airway device
- S: Surgery type
Each factor is assigned a score to quantify the risk.
What is recommended for well-controlled asthma patients before elective surgery?
Use of inhaled beta 2 agonist 1-2 hours before surgery.
This helps reduce the risk of bronchospasm.
What should be done for poorly controlled asthma patients before elective surgery?
Use of systemic corticosteroids 3-5 days prior to surgery and inhaled beta 2 agonist.
This is to prevent adrenal crisis during surgery.
What is the recommended timing for elective surgery after the last asthma attack?
4-6 weeks.
This allows time for stabilization of the patient’s condition.
What should be continued up to the day of surgery for asthma patients?
All maintenance asthma medications.
This is crucial for maintaining control of asthma symptoms.
What is a key consideration in the preoperative evaluation of a child with asthma?
Establish if the child has undiagnosed asthma or a known case of bronchial asthma.
This includes reviewing the level of asthma control and current medications.
