Preop/Postop Care Flashcards
Cardiac functional status is expressed in ______.
Metabolic equivalents (METS)
●Can take care of self, such as eat, dress, or use the toilet (1 MET)
●Can walk up a flight of steps or a hill or walk on level ground at 3 to 4 mph (4 METs)
●Can do heavy work around the house, such as scrubbing floors or lifting or moving heavy furniture, or climb two flights of stairs (between 4 and 10 METs)
●Can participate in strenuous sports such as swimming, singles tennis, football, basketball, and skiing (>10 METs)
Considerations when grading cardiac risk for a surgery:
●Surgery-specific risk (RCRI & NQSIP).
●History of ischemic heart disease (RCRI).
●History of heart failure (RCRI).
●History of cerebrovascular disease (RCRI).
●Insulin dependent diabetes mellitus (RCRI).
●Preoperative serum creatinine ≥2.0 mg/dL (RCRI) or >1.5 mg/dL (NSQIP).
●Increasing age (NQSIP).
●American Society of Anesthesiologist class (NSQIP).
●Preoperative functional status (NSQIP).
2 key surgical cardiac RF include:
Atrial fibrillation
Obesity
Patients whose estimated risk of death is less than ____ are labeled as being low risk and require no additional cardiovascular testing.
1%
In patients who can perform ≥ ___ METs of activity, we do not order additional tests.
4
Patients with:
- Dyspnea of unknown origin
- Worsening HF
- Suspected valve disease or cardiac dysfunction
Should receive a _______ (test) prior to surgery.
Transthoracic echocardiogram
Some PE signs that suggest HF or cardiomyopathy are:
- Resting tachycardia
- Elevated JVP
- Displaced apical impulse
- Third and/or fourth heart sound
- Murmur of mitral regurgitation
RF for the development of HF include:
- History of alcohol or cocaine abuse
- Prior myocardial infarction
- Prior cardiotoxic chemotherapy
- Longstanding hypertension
- Family history of HF
- Diabetes mellitus.
Left ventricular ejection fraction ≤ ____ (percentage) has been shown to predict adverse outcomes in patients who underwent intermediate- or high-risk noncardiac surgery
30%
Withholding an ACE-I or ARB on the day of surgery may help prevent intraoperative _______.
Hypotension
*Beta blocker therapy should be continued!
Pre-operative creatinine > ___ mg/dL / 176.8 µmol/L is of concern
2
*Recommended to only obtain serum creatinine in:
•Patients over the age of 50 undergoing intermediate or high risk surgery
•Younger patients suspected of having renal disease, when hypotension is likely during surgery, or when nephrotoxic medications will be used
Important RFs to discuss before surgery include:
Age, exercise capacity, alcohol, smoking, illicit drug use, and medication use.
Baseline hemoglobin measurements recommended for all patients ≥ ___ y/o undergoing major surgery and younger patients undergoing surgery that is expected to result in significant blood loss.
65
We suggest NOT testing for serum electrolytes, blood glucose, liver function, hemostasis, hemoglobin, WBC, or urinalysis in the healthy preoperative patient
YAY
Guidelines for obtaining a preop ECG are…
A resting 12-lead ECG should be part of the evaluation in patients with known coronary artery disease, significant arrhythmia, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease, except for those undergoing low-risk surgery.
