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2-General Anesthesia Exam 1 > Preoperative Assessment > Flashcards

Preoperative Assessment Flashcards

1
Q

What are seven golden questions that must be incorporated into a preoperative assessment?

A 
Identify patient
NPO status
Allergies
Medications
Medical/surgical history
General anesthesia in the past
Evaluation of airway
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2
Q

What is the ASA physical status classification?

A
  • Widely used classifications system (risk stratification)
  • Grading system for “preoperative health”
  • Universal coding system or “language” for anesthesia providers, used in billing and reimbursement
  • Assigned to every anesthetic patient
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3
Q

When was the ASA physical status classification developed?

A

1963

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4
Q

What is the ASA physical status classification scale associated with?

A

increased mortality & Morbidity (questionable predictive capability)

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5
Q

The ASA physical is ________ in interpretation and score rendered.

A

highly variable

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6
Q

ASA I refers to a ______________ individual.

A

Healthy

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7
Q

ASA II refers to a ______________ individual.

A

Mild systemic disease

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8
Q

ASA III refers to a ______________ individual.

A

Moderate to severe disease with functional limits

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9
Q

ASA IV refers to a ______________ individual.

A

Severe disease & functional incapacity

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10
Q

ASA V refers to a ______________ individual.

A

Survival limited to less than 24 hours without intervention

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11
Q

ASA VI refers to a ______________ individual.

A

Organ donor

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12
Q

Review goals of a preoperative assessment

A

Slide 56

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13
Q

What is informed consent?

A

“Informed consent is grounded in an ethical and legal concept-that patients have the right to understand what is being done to their bodies (personal autonomy) and agree to the potential consequences of the healthcare intervention (self-determination and self-decision).” (Scheutzow, 2001 as cited in AANA, 2016)

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14
Q

True or False. Anesthesia consent is apart of surgical consent?

A

False: Once implied as part of the surgical consent; now separate process

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15
Q

What can occur without anesthesia consent (3)?

A

Without: risk of battery, negligence (to inform patient of risk and alternatives to care), and breach of contract

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16
Q

What are some questions you can ask yourself when evaluating a preop assessment (3)?

A
  • Is this person in an optimal state of health?
  • Can the patient’s condition be improved prior to surgery?
  • Does the patient have any health conditions which may influence the perioperative period? (Can I improve any of these conditions? What do I need to avoid? What could possibly go wrong with this patient and given surgery and what can be done to prevent?)
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17
Q

Who should be evaluated for a preop assessment? (6)

A

Any person receiving: General anesthesia, Regional anesthesia, Monitored anesthesia care (MAC), Urgent cases, Emergency cases, trauma cases

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18
Q

What is important to notify your patients about regarding a DNR?

A

DNR is usually suspended during surgery, important the family and pt is aware of this information

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19
Q

What are the joint commission requirements of a preop assessment?

A

The Joint Commission does not dictate components of the evaluation per se (follow professional practice standards); dictates timing and who is eligible to evaluate and provide sedation and anesthesia

-Moderate sedation versus Deep sedation/Regional/General anesthesia

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20
Q

What is Standard TX 2.1?

A

A pre anesthesia or pre sedation assessment is performed for each patient before beginning moderate or deep sedation and before anesthesia induction.

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21
Q

What is intent TX 2.1?

A

BEFORE sedation is given the anesthesia provider should consider data from other assessments and collect information needed to select a safe and effective anesthetic.

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22
Q

Review CRNA scope of practice by the AANA

A

Slide 62-64

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23
Q

Lack of symptoms are not the same as a _______

A

healthy patient

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24
Q

Serious abnormalities can exist without a ______; Increase in ambulatory _________

A

Diagnosis; patient acuity

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25
Q

Ask appropriate questions about symptoms and activity to aid in ______________

A

identifying unknown disease

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26
Q

What does the AANA and joint commission say about preop assessment?

A

a patient is seen immediately before anesthesia and care updated accordingly

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27
Q

What are options regarding timing of preop evaluation?

A

Several options depending on patient and procedure: Several days pre-op, Day of surgery and immediately pre-op

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28
Q

What are the effects of doing a preop assessment several day before surgery?

A

An evaluation before DOS is not always possible and the timing does not always affect anesthesia outcome, person doing case usually not the one to initially evaluate patient

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29
Q

What are the effects of doing a preop assessment day of surgery?

A
  • Older patients; complex procedures (challenge)

- OR turnover time pressures (time is money)

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30
Q

What are the effects of doing a preop assessment day if immediately pre-op?

A

urgent and must proceed having done a thorough assessment will guide your anesthetic interventions

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31
Q

What can a preop assessment DOS pick up (5)?

A

can pick up inappropriate fasting, airway issues, preexisting conditions, changing conditions, missed labs, etc.

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32
Q

What are characteristics of preop evaluation forms (4)?

A
  • Many are using EHR
  • Each institution/health system uses a standardized form to guide the assessment
  • Forms may be tailored to outpatient versus inpatient procedures
  • These forms are not standardized - quite variable
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33
Q

It is imperative to devise and practice a __________ that allows you to comprehensively evaluate yet individualize to a patient’s comorbidities, symptoms, and surgery

A

preop anesthesia assessment

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34
Q

An effective preop assessment should be _______ and _________

A

Systematic and complete

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35
Q

Review components of the preop evaluation

A

Slide 68

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36
Q

What should be included when evaluating patient history? (8)

A
  • General health history
  • Age, height, weight
  • Activities of daily living
  • Chronic conditions / Previous admissions
  • Previous surgeries / Anesthetic issues
  • Medications / Allergies
  • Alcohol, tobacco, etc.
  • Nutritional status
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37
Q

Why is important to obtain an anesthesia history?

A

Problems with anesthesia, intubation, bleeding, jaundice after anesthesia, PONV, family history of problems with anesthesia (MH), etc.

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38
Q

What information can be obtained by reviewing prior anesthesia records? (3)

A

Airway management, Requirements of anesthetics, Pre-existing conditions

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39
Q

What must be known about current medication history?

A

Name, Dosage (last taken), frequency

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40
Q

What must be known about allergies?

A

True allergies vs. side effects

Study of 1,800 patients:
28% claimed to have an allergy
50% of those were judged to be true allergies (Half of those claiming to have allergies actually had side effects)

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41
Q

Why is it important to understand what medications were taken DOS?

A

Important to get a sense of what is okay to take DOS and what needs to be held and for how long

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42
Q

Review medications that can/canont be taken DOS

A

Slide 72

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43
Q

What are the effects of giving antihyperglycemic DOS?

A

risk for hypoglycemia vs scheduling surgery/fasting vs. ability to monitoring intraop

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44
Q

What are the effects of giving anticoagulants DOS?

A
  • important because of surgical bleeding risk and regional anesthesia
  • Guidelines published by American Society of Regional Anesthesia and Pain Medicine (ASRA); always check institutional guidelines as well - some even more conservative
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45
Q

What are components of social history (5)?

A

Non-prescription drugs, Nutritional status, Socioeconomic status, Spiritual needs, Preferred name/pronoun

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46
Q

What are two important components of social

(sexual) history?

A
  • When in doubt, ask, especially given the fluidity of gender identity
  • Careful with pronouns on how you introduce to other providers
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47
Q

What impact does tobacco have on the cardiovascular? (3)

A

Coronary artery disease, peripheral vascular disease, cerebral vascular disease

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48
Q

What impact does tobacco have on the respriatory? (2)

A

COPD, reduced lung function

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49
Q

What impact does tobacco have on the gi? (5)

A

Peptic ulcer disease, GERD, gum disease, tooth decay, cancer of the oropharynx

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50
Q

What ganglion stimulant effect does Nicotine have on the body (4)?

A

(Toxic alkaloid)

  • Elevated HR
  • Elevated BP
  • Increased myocardial oxygen demands
  • Increased peripheral vascular resistance
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51
Q

What effect does carbon monoxide have on the body?

A

Readily occupies the oxygen-binding sites of hemoglobin

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52
Q

__________times the affinity for hemoglobin compared with oxygen

A

250-300

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53
Q

What is the half life of nicotine?

A

40-60 minutes

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54
Q

What is the half life of CO at room air? What is the impact of oxygen? Hyperbaric oxygen?

A

Half-life of COat room air is 130-190 min. 100% oxygen reduces thehalf-lifeto 30-90 minutes; hyperbaric oxygen at 2.5 atm with 100% oxygen reduces it to 15-23 minutes

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55
Q

What is the shortest amount of time patients should stop smoking prior to anesthesia?

A

Patients should not smoke for at least 12-48 hrs prior to anesthesia

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56
Q

What will happen if a pt stops smoking at least 12-48 hours before anesthesia?

A

12 hrs will start to decrease the deleterious effects of nicotine and CO

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57
Q

What is the belief that some surgeons have regarding smoking cessation?

A

Some surgeons (plastics especially) require longer cessation to achieve better wound healing (3-4 weeks)

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58
Q

What is true regarding smoking cessation and preop assessment?

A

The preop assessment is being used and documented as a touchpoint to teach patients about smoking hazards and encourage cessation (may be more amenable at that point)

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59
Q

What are the short term effects of smoking cessation?

A

Reduces the detrimental effects of nicotine and CO on cardiovascular and respiratory function

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60
Q

What are the effects of smoking cessation for one night pre op?

A
  • Reduces HR, BP, circulating catecholamines

- Allows carboxyhemoglobin levels to return to normal leading to better oxygenation

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61
Q

Heavy smokers: have a ____________ increase in postoperative pulmonary complications.

A

Six hold

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62
Q

How many weeks is needed before appreciable improvement is seen on pulmonary mechanics?

A

Eight weeks

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63
Q

What impact does eight weeks of smoking cessation have on pulmonary system (4)?

A
  • Enhanced ciliary function
  • Decreased mucus secretions
  • Decreased small airway obstruction
  • Improved immune function
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64
Q

What impact does second hand smoke have on the body (after 10 weeks)? (6)

A
  • Increased reactive airway disease
  • Abnormal pulmonary function tests
  • Increased respiratory infections
  • Laryngospasm
  • Coughing on emergence and induction
  • Postoperative desaturations
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65
Q

________ individuals are dependent on alcohol in U.S. alone

A

14 million

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66
Q

What is difficult regarding alcohol ingestion?

A
  • Difficult to accurately assess patient’s usage (also true of illicit substances)
  • Need to Type, Amount, Frequency
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67
Q

What is the definition of chronic alcoholism for women?

A

low-risk drinking is defined as no more than3 drinkson any single day and no more than7 drinksper week.

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68
Q

What is the definition of chronic alcoholism for men?

A

low-risk drinking is defined as no more than4 drinks on any single day and no more than14 drinksper week.

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69
Q

What is the surgical morbidity for those with alcohol use disorders?

A

Individuals with alcohol use disorders have 2-3 fold increase in surgical morbidity

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70
Q

What are some complications of chronic alcoholism?

A

Bleeding (liver), infection, cardiac insufficiency (increased tolerance or exaggerated effects to some anesthetic agents)

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71
Q

What is the effects of chronic alcohol use on the neurological system?

A

Dementia, cerebellar degeneration

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72
Q

What is the effects of chronic alcohol use on the cardiovascular system?

A

Cardiomyopathy, HTN, CVA

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73
Q

What is the effects of chronic alcohol use on the GI system?

A

Poor nutritional status, gastritis, pancreatitis, varices

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74
Q

What is the effects of chronic alcohol use on the hepatic?

A

Laennec’s cirrhosis, coagulopathies, hypoalbuminemia

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75
Q

What impact does acute ingestion have anesthesia requirements?

A

Decreased anesthesia requirements

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76
Q

What impact does chronic ingestion have anesthesia requirements?

A

Increased anesthesia requirements

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77
Q

What are the increased anesthesia requirements from chronic alcohol ingestion?

A
  • Enzyme induction

- Volatile agents compete with ethanol for binding on neuronal gamma-aminobutyric acid (GABA) and glycine receptors

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78
Q

What are the increased anesthesia requirements from chronic alcohol ingestion, specifically propofol and opioids?

A

Propofol and opioids such as alfentanil are increased. The increased anesthetic requirements can exacerbate the risk of cardiovascular instability in patients who may be suffering from cardiomyopathy, heart failure, or dehydration

79
Q

What is the regulation of herbal preparations?

A
  • Not regulated by FDA
  • Dosage and efficacy not regulated
  • Marketed for “health promotion”; no medicinal value
80
Q

_____of surgical patients take one or more herbal supplements

A

17% of surgical patients take one or more herbal supplements

81
Q

What are important about the characteristics of herbal preparations?

A
  • Patients may equate “all natural” with safe

- Some preparations contain heavy metals

82
Q

What have studies identified in herbal preparations?

A

prednisone, testosterone, and theophylline in herbal preparations

83
Q

What is St. John’s Wart used for (3)? How many americans use it regularly?

A
  • Used for anxiety, depression, sleep disorders

- 7.5 million Americans take regularly

84
Q

What is Ginkgo Biloba used for (2)? How many americans use it regularly?

A
  • Used to improve memory, enhance blood circulation

- 11 million Americans take regularly

85
Q

What impact does St john’s wart have on anesthesia?

A

May intensify or prolong the effects of opioids and thus the anesthetic

86
Q

What impact does ginkgo bilbo have on anesthesia?

A

Acts as an anticoagulant, May reduce platelet function and clotting formation

87
Q

What is the most popular herbal preparation? What impact does it have?

A
  • Ginseng

- Used for vitality, fatigue, and cancer prevention

88
Q

What impact does Ginseng have on anesthesia?

A
  • May cause episodes of tachycardia and hypertension

- May have anticoagulant properties

89
Q

What are the four common herbal supplements associated with increased bleeding?

A

4 G’s: garlic, ginseng, gingko, ginger (and Vit E)

90
Q

Post pubescent, pre-menopausal females should be informed that the administration of anesthesia during _______ may be associated with miscarriages and preterm labor along with birth defects

A

pregnancy

91
Q

What is important regarding pregnancy test?

A

Home tests are not reliable, A negative hospital test is NOT an absolute as up to 10 days must pass after conception for a positive test

92
Q

What is the approach regarding addressing females of childbearing years?

A

Policies established by the medical staff and institution will govern the individual facilities approach to females of childbearing years

93
Q

Perform the respiratory component of a preoperative assessment.

A
  • Dyspnea
  • Activity tolerance
  • Asthma, bronchitis
  • Smoking history
  • Cough or wheezing
  • Snoring? CPAP/Obstructive sleep apnea (OSA)?
  • Recent colds or URI (evaluate temp, WBC, mucus)
  • Breath sounds – must auscultate
94
Q

When is chance of cold or URI at its highest risk of occurrence?

A

Highest risk immediately after recovery

95
Q

What is the S refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

Snoring-Do you snore loudly?

96
Q

What is the T refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

Tiredness-Do you often feel tired, fatigued or sleepy during the daytime?

97
Q

What is the O refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

Observed Apnea- Has anyone observed that you stop breathing or choke or gasp during your sleep?

98
Q

What is the P refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

High Blood Pressure-Do you have or ar you being treated for high blood pressure?

99
Q

What is the B refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

BMI (Is your body mass index more than 35 kg/m2)

100
Q

What is the A refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

Age (Are you over older than 50 years?)

101
Q

What is the N refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

Neck circumference (Is your neck circumference greater than 40 cm)

102
Q

What is the g refer to in STOP-Bang? Which question should you ask incorporate in your assessment to evaluate this component?

A

Gender (Are you male?)

103
Q

______of patients 30-70yo have OSA

A

26%

104
Q

What are criteria for being at risk of OSA?

A

episodic desaturation, hypercapnia, pulmonary HTN, right heart failure

105
Q

A score on the STOP-Bang of 0-2 equals what level of risk?

A

Low

106
Q

A score on the STOP-Bang of 3-4 equals what level of risk?

A

intermediate risk

107
Q

A score on the STOP-Bang of >5 equals what level of risk?

A

High risk

108
Q

What are considered high alert for cardiovascular disorders ?

A

uncontrolled HTN, unstable heart disease (MI, CHF, arrythmias, valvular heart disease, etc.)

109
Q

What high risk procedures non cardiac surgery can cause cardiac patients (HTN, MI, CHF, anemia, angina, exercise tolerance, smoking history, males >40yo and females >50yo) to have increased risk of complications?

A
  • Abdominal, orthopedic, vascular

- Cases involving large blood loss or large abdominal incisions

110
Q

What needs to be apart of the preop assessment for cardiac patients (HTN, MI, CHF, anemia, angina, exercise tolerance, smoking history, males >40yo and females >50yo)?

A
  • EKG if any of the above

- Consider echo/stress evaluation depending on type of surgery and comorbidities

111
Q

What do pts with HTN need before surgery?

A

Patients with HTN should have end organ involvement assessed (Renal, CNS, CAD, assess for carotid bruits)

112
Q

What is the recommended blood pressure parameters during the periperative period?

A

Blood pressure in the perioperative period should be maintained within 20-30% of baseline (Obtain baseline measure)

113
Q

What is important about AICD and pacemakers?

A
  • AICD and pacemakers must be managed appropriately, especially if electrocautery will be used during the procedure
  • Important to know if is device is magnet responsive, may need to be reprogrammed
114
Q

According to the NY Heart Association Functional Classification of Cardiovascular Disability, what is a class I?

A

Patients with cardiac disease

115
Q

According to the NY Heart Association Functional Classification of Cardiovascular Disability, what is a class II?

A

Patient with cardiac disease who are comfortable at rest

116
Q

According to the NY Heart Association Functional Classification of Cardiovascular Disability, what is a class III?

A

Patients with cardiac disease resulting in marked limitations to physical activity

117
Q

According to the NY Heart Association Functional Classification of Cardiovascular Disability, what is a class IV?

A

Patients with cardiac disease resulting inability to carry on any physical activity without discomfort

118
Q

Why is exercise tolerance an important predictor of perioperative risk for noncardiac surgery?

A

assessment can direct need for further testing/invasive monitoring (Assess with treadmill or METS questionnaire)

119
Q

What does METS referred to?

A

Metabolic equivalents, Ratio of your working metabolic rate relative to your resting metabolic rate

120
Q

Review METS table.

A

Nagelhout Table 20.7

121
Q

What does One MET mean?

A

is defined as the energy you use when you’re resting or sitting still (consumption of 3.5 ml O2/kg/min)

122
Q

What does 4 mets mean?

A

means that you are exerting four times the energy than you would if you were sitting still

123
Q

What does a met score of 4 or more mean?

A

METS score of 4 or more predicts low risk of perioperative complications

124
Q

Perform the neurological part of a preop. assessment?

A
  • Mental status
  • Hx of seizures, episodes of syncopy, headaches
  • Reflexes, cranial nerves
  • Cervical neck disease
  • Neuropathies
125
Q

______ increase in morbidity and mortality in diabetic patients having surgery

A

5-10%

126
Q

Perform the endocrine part of a preop. assessment?

A

DM, Steroid usage, Thyroid dysfunction, Evaluation of neck and trachea if enlarged thyroid noted

127
Q

What is the goal for glucose monitoring?

A

Goal glucose less than 200 mg/dl

128
Q

What is important to know about morning oral hypoglycemic agents?

A

held day of surgery

129
Q

When is metformin held? Why?

A

Metformin in held DOS (Concern: lactic acidosis)

130
Q

When is morning regular insulin held?

A

-Morning regular insulin is held day of surgery (unless glucose >200)

131
Q

What about long-acting insulin being held for surgery?

A

*1/2 SQ dose DOS of long-acting insulin

132
Q

What must be done to insulin pumps during surgery? Who should be consulted?

A
  • Insulin pumps are usually reduced, NOT stopped the morning of surgery (check glucose q 1hr intraop- with any infusion)
  • Consult with endocrinologist
133
Q

What is the requirement for blood sugar documentation during surgery?

A

Blood glucose for IDDM patient must be documented on the anesthesia record prior to induction and should be checked at least every 1-2 hours during general anesthesia

134
Q

What happens to the adrenal gland after exogenous steroids?

A

adrenal gland atrophy

135
Q

What impact does a patient taking exogenous steroid have during surgery?

A

Adrenal-cortical suppression, Adrenal gland unable to respond to the demands of increased stress i.e. induction and surgery, bleeding, etc.

136
Q

Principal glucocorticoid steroid is ________

A

cortisol

137
Q

Adrenal gland secretes up to ________ of hydrocortisone daily when subjected to maximum stress

A

500 mg

138
Q

What can happen to suppressed adrenal function patients who do not receive supplemental steroids?

A

Few patients with suppressed adrenal function have perioperative cardiovascular events if they are not supplemented with steroids pre-operatively

139
Q

Although acute adrenal insufficiency occurs rarely, it is a ________

A

life-threatening event

140
Q

There is little risk in administering a ______dose of steroids pre-operatively to patients who have been taking them

A

single

141
Q

When should corticosteroid coverage be given?

A

Coverage is given if the patient has been taking steroids for 7 days within the last year

142
Q

According to barash when should corticosteroid coverage occur?

A

at least 1 month of therapy past 6-12 mos.

143
Q

What is important to know about the corticosteroid coverage?

A

“There is no universally agreed-upon dose or duration of exogenous steroids required to cause HPAA dysfunction” (Liu et al., 2017, Anesthesiology)

144
Q

Review table in barash regarding corticosteroid coverage?

A

Slide 101

145
Q

Perform the gastrointestinal portion of the preoperative assessment.

A
  • NPO status
  • Hiatal hernia
  • Ulcers
  • Obesity
  • GERD
146
Q

What is important about pre-operative fasting?

A

Reduce the risk of aspiration on induction of anesthesia and postoperative emesis

147
Q

What must preoperative fasting be balanced with?

A

hypoglycemia and dehydration

148
Q

Traditionally NPO after ______ regardless of surgery time, procedure or bowel prep

A

midnight

149
Q

Review Box 20.21 in Nagelhout.

A

Slide 104

150
Q

What has recent studies demonstrated about preoperative fasting?

A

Several recent studies have demonstrated that 150 ml of clear liquids (tea, non-pulp fruit juices, black coffee, carbonated beverage) had no impact on gastric pH or volume when ingested up to 2-3 hours preoperatively

151
Q

How long does it take solids food to be digested? What can affect this?

A

Solids must be digested into 2mm bolus before leaving the stomach via the pylorus
This process takes 6-8 hours depending on the type of food (toast vs meat)

152
Q

What does the ASA Taskforce recommend regarding preoperative fasting?

A

ASA Taskforce on preoperative fasting suggests the use of pharmacologic agents to reduce the risk of aspiration in healthy patients is not recommended

153
Q

What are some examples of pharmacologic agents that can be used to reduce the risk of aspiration?

A

Reglan, H2 blockers, Antacids, Antiemetics

154
Q

What is the criteria for increased risk of aspiration?

A
  • Extremes in age; below 1 year or above 70 years
  • Anxiety
  • Ascites
  • Esophageal procedures or dysfunction
  • Metabolic disease,( i.e. obesity or DM)
  • Pain
  • Pregnancy
  • hiatal hernia
  • bowel obstruction (including appendicitis)
  • Narcotics
  • GERD
155
Q

What is mendelson’s syndrome?

A

Described as aspiration pneumonitis in 1946, Aspiration of gastric content with resultant bacterial pneumonia

156
Q

What are the criteria for individuals at greatest risk of mendelson’s syndrome?

A
  • pH less than 2.5

- Gastric content greater then 25ml (0.4 mL/kg)

157
Q

When is pulmonary aspiration most common?

A

Pulmonary aspiration more common with emergencies rather then elective intubations

158
Q

What does the Warner study demonstrate?

A

1:71,829 mortalities related directly to pulmonary aspiration

159
Q

What are the two types of aspiration?

A

Acid Aspiration & Particular Aspirate

160
Q

What is acid aspirate?

A

Atelectasis, Alveolar edema, Loss of surfactant

161
Q

What is particulate aspirate?

A

Small airway obstruction, Alveolar necrosis, Granuloma formation around food particles

162
Q

What will appear on a chest xray with aspiration pneumonia?

A

Will see diffuse bilateral infiltrates within hours on CXR

163
Q

What are the assessment findings of aspiration pneumonia? 6

A

Intra pulmonary shunting, pulmonary edema, Hypercapnia, Wheezing, Tachycardia, Hypotension

164
Q

How can nonparticulate antacids prevent aspiration? When would this be considered?

A

sodium citrate (15-30 cc)

  • Raises pH in the stomach >2.5
  • Considered in patients with high risk of aspiration (C-section, emergencies)
165
Q

How can H2 blockers prevent aspiration?

A
  • Block hydrogen ion release by gastric parietal cells

- Will not alter pH of gastric content already in stomach

166
Q

What are examples of H2 blocker medications?

A

Ranitidine, cimetidine, famotidine

167
Q

How can proton pump inhibitors prevent aspiration?

A

Cause dose dependent intracellular inhibition of gastric acid secretion affecting gastric volume

168
Q

What are examples of proton pump inhibitors medications?

A

Omeprazole (Prilosec), esomeprazole (Nexium) , lansoprazole, rabeprazole

169
Q

What are gastro kinetic agents and how do they help prevent aspiration?

A
  • Decreases gastric volume by increasing gastric emptying time without changing pH
  • Increases lower esophageal sphincter tone while relaxing pyloric sphincter tone and enhancing gastric motility
170
Q

What is an example of a gastro kinetic agent? When is a gastrokinetic agent contraindicated?

A

Metoclopramide (not to be used with small bowel obstruction)

171
Q

What are some ways to prevent aspiration pneumonia? (4)

A

True or modified rapid sequence induction, Appropriate NPO status, Proper assessment of risk factors and Pre medication when conditions dictate (reglan and citrate).

172
Q

What is true rapid sequence induction?

A

True = Cricoid pressure with no ventilation

173
Q

What is modified repid sequence induction?

A

Modified = Cricoid pressure with ventilation

174
Q

What are treatment options for pneumonia?

A
  • Head to the side to promote gastric content drainage from mouth
  • Pharyngeal and tracheal suctioning
  • Positive pressure ventilation
  • Intubation
175
Q

What is involved in the intubation component of pneumonia treatment (5)?

A
  • PEEP
  • Bronchoscopy and lavage
  • Antibiotics and steroids
176
Q

Review a renal assessment for the preoperative assessment.

A
  • Assess current kidney function
  • BUN, creatinine, electrolytes
  • Anemia
  • Will impact drug metabolism and clearance
  • If dialysis, when was last treatment?
177
Q

What are some general tips to conducting an effect preoperative assessment?

A
  • Conduct in a relaxed and unhurried manner
  • Use direct questions to avoid long drawn-out stories
  • Avoid medical jargon (anticoagulants vs blood thinners)
178
Q

What is important to know about performing preoperative lab testing?

A

Usually dictated on a disease-based criteria and results will benefit the management of the patient

179
Q

What are some common lab tests that are seen preoperative?

A

CBC, Chemistry panels, Liver panels, Coags, ECG, CXR, Stress test

180
Q

____-_____% of abnormalities are not followed up on or even recorded on the anesthesia record

A

30-90%

181
Q

What should be used to guide the ordering of preoperative testing?

A

An accurate history and physical should predict abnormalities

  • Evaluate the benefit-risk ratio
  • If this test is abnormal, how will it change my care for this patient?
182
Q

Who are most at risk to alterations on an ECG?

A

diabetes & HTN

183
Q

What is the minimal age based testing for ECG?

A

Minimal age-based testing has risen to 65 for screening (current if within 1 yr)

184
Q

According to the AHA, who should receive a preoperative ECG?

A

Guidelines per AHA: ECG for those with known CAD or structural heart disease; a consideration in asymptomatic patients with clinical risk factors (except low-risk procedures)

185
Q

What does a Q wave on a preop ECG indicate?

A

A Q wave on a preop ECG in a high-risk patient - red flag!

186
Q

What is the recommendation for preoperative CXR?

A

Not considered beneficial as screening for anyone less than 75

187
Q

No one drug or combination of drugs provides ideal _______ for all patients in all types of surgical situations

A

premedication

188
Q

What can help a provider choose an appropriate premedication plan for the patient?

A

Age, weight, allergies, medical condition, concurrent medication, mental status, elective vs emergent surgery, etc.

189
Q

Review some goals of premedication

A

Slide 122

190
Q

What are the elements of informed consent?

A

Competence and decision-making capacity, Disclosure of information, Understanding of disclosed information, Voluntary consent and Documentation

191
Q

Informed consent elements: Define Competence and decision-making capacity

A

The patient has the legal authority to consent (competence) and the ability to decide to receive specific anesthesia care (capacity).

192
Q

Informed consent elements: Define Disclosure of information

A

The patient is adequately informed of relevant information, including at a minimum:

  • Nature and purpose of the proposed anesthesia technique(s)
  • Risks, benefits, side effects of anesthesia technique(s)
  • Alternatives and their risks, benefits, and side effects -
  • Risks of not receiving the anesthesia care
193
Q

Informed consent elements: Define Understanding of disclosed information

A

The patient demonstrates understanding of the information disclosed and presented by the anesthesia professional.

194
Q

Informed consent elements: Define Voluntary consent

A

The patient voluntarily consents to the planned anesthesia care in the absence of coercion or duress. healthcare record contains appropriate documentation evidencing the patient’s informed consent for anesthesia.

2-General Anesthesia Exam 1 (7 decks)

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