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Basics EXAm 1 > PreOp & Preparation > Flashcards

PreOp & Preparation Flashcards

1
Q

What is METS?

A

Metabolic Equivalent of Task; a subjective assessment of a patients cardiopulmonary capacity

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2
Q

Poor cardiopulmonary capacity is associated with

A

Increased perioperative risks

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3
Q

1 MET is the rate of

A

Energy consumed at rest (3.5mL/kg/min)

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4
Q

What is a good functional capacity in terms of METS?

A

Greater than 4=low risk

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5
Q

When should you avoid cardiac surgery as it relates to recent MI/CABG or PCI?

A

BMS> 1mo

DES 3-6 mo, continue ASA

CABG >6 mo

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6
Q

Stage 2 HTN range

A

> 140/>90

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7
Q

Which valvular disease is most concerning?

A

Severe Aortic Stenosis (valve area <1.0)

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8
Q

What test is the gold standard for cardiac evaluation?

A

ECHO

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9
Q

Preserved EF>50% is considered to be _____ risk

A

Lower

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10
Q

What are s/s of Left ventricular dysfunction?

A

SOB

Pulmonary Edema

Tachypnea

Tachycardia

JVD distention

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11
Q

What is the definitive test for IHD (ischemic heart disease)?

A

Cardiac Catheterization

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12
Q

What Pulmonary assessment tool can be used to assess function?

A

STOP-BANG (assessment for OSA)

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13
Q

What does STOP BANG stand for?

A

Snoring
Tired
Observed stop breathing
Blood Pressure

BMI>35
Age>50
Neck circumference>40
Gender Male

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14
Q
A
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15
Q

What is a normal FEV1/FVC ratio?

A

Greater than or Equal to 80%

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16
Q

FEV1/FVC ratio less than 80% suggests

A

Airflow limitation with an obstructive pattern

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17
Q

What are examples of reversible airway diseases?

A

Asthma

Chronic Bronchitis

Emphysema

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18
Q

Steroids can lead to

A

Adrenal insufficiency

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19
Q

With upper respiratory infections, how long should an elective case be post-poned?

A

6 week in adults; okay to proceed in children due to frequent URI

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20
Q

Diabetes is associated with what other diseases?

A

HTN
CAD
PVD
Renal Insufficiency
Slow GI motility

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21
Q

When do you treat a BS?

A

> 180

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22
Q

What medication is used to treat HYOthyroid?

A

Synthroid

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23
Q

What medication is used to treat HYPERthyroid?

A

Propylthiouracil & Propranolol

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24
Q

Should thyroid medication be held?

A

No, continue them

25
Q

Who is at risk for HPA axis suppression?

A

Those who take high doses of steroids like 20mg for >5 days in the prior year

26
Q

HPA axis suppression may manifest as

A

HOTN that is not corrected by fluids or vasopressors

27
Q

With Minor surgeries, what is the target for hydrocortisone?

A

50mg

28
Q

With Moderate surgeries, what is the target for hydrocortisone?

A

75-150mg/day

29
Q

With Major surgeries, what is the target for hydrocortisone?

A

75-150mg/day

30
Q

IBW calculation for Males?

A

IBW= 50kg + 2.3 kg fir each inch over 5 feet

31
Q

IBW for females?

A

IBW= 45.5 kg +2.3kg for each inch over 5 feet

32
Q

Advanced RA can cause

A

Vocal cord restriction & tracheal stenosis

33
Q

How long should anticoags be held for regional

A

3 days

34
Q

Which populations are at an increase risk for aspiration?

A

OB
GERD
Obese
DM
Pain
HYPOthyroid

35
Q

NPO status causes

A

Dehydration
Low BS
Hypovolemia
Increased Preop anxiety

36
Q

Clear liquids can be consumed up til

A

2 hours

37
Q

Breast milk minimal fasting time

A

4 hours

38
Q

Infant formula minimal fasting time

A

4-6 hours

39
Q

Non human milk minimal fasting time

A

6 hours

40
Q

Light meal minimal fasting time

A

6 hours

41
Q

Heavy meal with a lot of fat & meat minimal fasting time

A

8 hours

42
Q

How is Cisatracurium metabolised?

A

Plasma Esterase, so independent of organ function

43
Q

What is the optimal time frame to quit smoking

A

> 2 months, but can see changes from even a few days

Should stop at least 12-48 hours before surgery

44
Q

Alcohol should be abstained for

A

4+ weeks before major surgery

45
Q

What tools are used for ETOH assessment?

A

AUDIT

CAGE

46
Q

Those with a heavy consumption of alcohol may require

A

Increased doses of meds & they metabolize NMB more rapidly

47
Q

Opioid abuse can lead to

A

A harder time managing pain, especially is they take suboxone or naltrexone

48
Q

Those who abuse opioids are at risk of

A

Hyperalgesia, so use a multimodal approach

49
Q

Methamphetamine effects on anesthetic

A

Poor dentation

SNS activation

50
Q

Cocaine use risks

A

The chance of Coronary vasospasm (avoid ephedrine)

HTN

Tachycardia

51
Q

Which antiemetics should be used for gastric bypass?

A

Aprepitant

Emend

52
Q

Extreme anxiety effects on anesthetic

A

Increased requirements

Delayed discharge

High post-op pain

53
Q

What home meds should be taken?

A

Beta Blockers

Inhalers

Anti-hypertensives

Anti-seizures

Parkinsons

Opioids

54
Q

What home meds should be HELD?

A

ACEI
ARBS
Diuretics
Vitamins
Herbals
Oral Hypoglycemics

55
Q

ASA class 2

A

Mild systemic disease

56
Q

ASA class 3

A

Severe systemic disease; 1 or more moderate to severe disease

57
Q

ASA class 4

A

Severe systemic disease that is a constant threat to life

58
Q

ASA class 5

A

Moribund; not expected to survive without an operation

59
Q

ASA 6

A

Declared to be brain dead; organ removal

Basics EXAm 1 (4 decks)

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