Preoperative Care Flashcards
Predictors of increased preoperative cardiac risk?
Major risk – unstable/severe angina, MI in the past month, decompensated CHF, arrhythmias, valvular disease
Intermediate risk – mild angina, previous MRI/Q leads, compensated CHF, diabetes
Minor risk – advanced age, nonsinus rhythm, abnormal ECG, Poor exercise tolerance, history of stroke, uncontrolled hypertension
Standard preoperative tests?
- For all: CBC, CXR, LFTs, UA electrolytes/glucose/creatinine
- ECG for men over 40 and women over 50 (unless history/symptoms of cardiac disease)
- PT/PTT platelets – if history reveals evidence of coagulopathic disorder
Preferred type of anesthesia to use? Unless?
Local anesthesia has fewer physiologic consequences than regional or general anesthesia
UNLESS
- patients experience increased pain and require large doses of IV sedatives
- Loss of peripheral vasoconstrictor ability (diabetic neuropathy)
- Inability to increase cardiac output when needed (CAD, low EF, valvular heart disease)
Major drawbacks of general anesthesia?
Pulmonary complications and mild cardiodepression
Preoperative management in patient that takes over the counter antiplatelet therapy?
- If aspirin – discontinue 7-10 days prior to procedure
2. If NSAID – discontinue for 2 days prior to procedure
Preoperative management of patient whose father and brother died of acute MIs at 45 years?
- Concentrated cardiac history (anginal symptoms, shortness of breath)
- ECG
- Exercise stress test advisable
Preoperative management if serum cholesterol is 320?
None. Hypercholesterolemia alone does not alter surgical plan
Preoperative management in patient whose EKG provides evidence of previous MI, but MI occurred without patients knowledge
- Cardiology consult
- Exercise stress test
- If ischemic, consider cardiac catheterization before surgery
Preoperative management if patient has diabetes?
- Still place patient NPO after midnight, but give IV dextrose
- Patients should NOT receive oral hypoglycemic agents morning of surgery
- If IDDM, check glucose levels the morning of surgery (higher glucose level is preferred to reduce level)
- If glucose level gain IDDM patient is over 250, give 2/3 of the morning does of insulin. If glucose level is less than 250, administer 1/2 of morning dose
Preoperative management if HCT is 34%?
Postpone surgery and look for cause of anemia – most common cause is colorectal cancer
Preoperative management if patient’s hematocrit is 55%?
Patient has either hypovolemia for polycythemia
- If you dehydrated, delay surgery
- If polycythemia, determine and treat cause prior to elective surgery 3. If polycythemic but necessary surgery, hydrate and phlebotomize to reduce risk of thrombotic complications
Common causes of polycythemia?
- Polycythemia vera
- COPD
- Renin-secreting tumors (renal cell carcinoma, hepatocellular carcinoma)
Preoperative management in patient 100 pounds overweight who reports becoming winded when walking up stairs?
- check medical evaluation – pulmonary status, ABG
- If ABG are abnormal, pulmonary functions test
- Use epidural to avoid atelectasis (or aggressively treat postoperatively)
Patient waiting to enter OR –
Known Diabetic with morning glucose of 320?
- Delay surgery – perioperative glucose levels should be 100-200 (Poorly controlled diabetes increases wound infections)
- Patient may need subcutaneous insulin +/- dextrose drip
Patient waiting to enter OR – notice cellulitis from infected hair follicle.
In terms of acute infections, carefully examine patients with this condition?
- If elective surgery, postpone until the infection is resolved (regardless of location) to minimize wound infection risk
- Diabetics – may have unknown toe/infections
