Preoperative Care Flashcards
According to ACC/AHA, what conditions are considered clinical predictors of increased perioperative cardiovascular risk?
- unstable coronary syndromes (unstable/sever angina or recent MI)
- decompensated HF (NYHA class IV; worsening or new onset HF)
- significant arrythmias (high grade AV block, mobitz II AV block, symptomatic ventricular arrythmias, supraventricular arrythmias)
How should peroperative testing be determined for a patient?
Based on history (assessment of risk factors) and physical…there is no STANDARD preop testing protocol
How to categorize patient’s anesthetic risk?
ASA class 1-5 based on perioperative morbidity and mortality 1 = you good fam 5 = u already dead nigguh
How to decide between local, general, and spinal anesthesia?
local has less physiologic consequences than local or general….but sometimes if not done effectively can increase pain and need for IV meds which can increase risk
spinal anesthesia may lead to fewer pulmonary complications than general, however do not use in patients with CAD, low cardiac reserve and low EF or peripheral neuropathy….because loss of peripheral vasoconstricto ability or ability to increase CO when necessary
general anesthesia allows excellent analgesa and amnesia while maintaining good physiologic control
IN THE END JUST CONSULT ANESTHESIOLOGIST
When to d/c NSAIDs and aspirin for elective procedure?
NSAIDS - 2 days before procedure
aspirin - 7-10 days before procedure
Preop management for relatively healthy patient with fmaily history of early MI
ECG and possible stress test, ask for symptoms of angina or SOB
preop management for patient with cholesterol of 320
chronically treat with lifestyle modification and possible management, but don’t postpone surgery just for this
Preop management of patient with previous inferior MI
re do ECG, consult cards, possible exercise stress test….if ischemia present, may need to do cardiac cath to see if revascularizaiton is needed before surgery
preop management for patient with DM
since NPO after midnight, patient needs IV dextrose to prevent hypoglycemia
- check blood glucose morning tightly morning of procedure (should be around 100-250)…if greater than 250, give 2/3rds morning dose if insulin NPH…if less than 250, give 1/2 morning dose in IDDM
preop management of patient with anemia
WORK UP ANEMIA first!, usually will be GI bleed or colorectal cancer but other causes should be worked up too
preop management of patient with Hct 55%
see if they are dehdydrated (give fluids) or if polycythemia vera (rare but impotant)
cuases of polycythemia vera 0 COPD or EPO secretingtumor like renal cell carcinoma or hepatocellular carcinoma)
What complications are obese patients more predisposed to?
- pulmonary hypoventilation, hypercapnia, and pulmonary HTN
- DVT
Perioperative managemnt of obese patient
- ABGs and PFTs to evaluate pulmonary function]
- consider postponing elective procedure if patient is willing to do weight loss program
- aggressive pulmonary support during procedure and epidural anesthesia and prophylaxis for atelectasis post op
- SCDs and heparin to prevent DVT post op
DM are more predisposed to what complication after procedure?
postoperative wound infection
Preop patient has cellulitis form infected hair follicle…
resolve any active infection before operating! REGARDLESS OF LOCATION
Preop patient burns on urination
get UA and culture…if UA positive or infection, surgery should be postponed until UTI resolved
Preop patient BP is 180/110…
keep using their Bblocker to avoid rebound HTN….diastolic greater than 110 is at risk for malignant HTN, acute MI, or CHF…but if less than or at 110, don’t delay procedure…
HTN patients are at higher chance to have their BP go up right before procedure
Operating on smoker…
STOP SMOKING 6-8 weeks before procedure and encourage smoking cessation!
Operating on patient with change in sputum to green
probably bronchitis…so treat with antibiotics and operate after procedure complete
Operating on blood streaked sputum (bloody for 3 weeks)
indicates active infection or malignancy!….do full work up including CXR and chest CT…bronchoscopy is also necessary to cehck for endobronchial lesions and obstain cytology samples
How to manage patient with urgent need for procedure (septic from acute cholecystitis) with advanced COPD…
- ABGs to determine pulmonary status (o2 should be greater than 60 and CO2 less than 45)
- pulmonary toilet and preoperative bronchodilators to improve pulmonary condition
- get info about patient’s preop pulmonary status
- if acute chole…give IVF, antibiotics and see if patient’s conditions improves…if it does you can postpone surgery, if not go ahead
- post op incentive spirometry
How to manage patient with urgent need for procedure….with SEVERE COPD..
these patients are high risk for pulmonary failure…
ask if patient is at baseline and if patient uses O2 at home
consider adjusting what procedure is performed (favorable open cholecystectomy becasue lapcholes are associated with increased CO2 absoprtion)
Why should patients undergoing revascularizations procedures have a thorogh cardiac risk assessment?
vascular surgery has a high risk for cardiac complications
do thorough workup!
Most common cause of early postop death following lower extremity revascularization?
MI!
patients with prior hx of MI risk is 15%
patients with recent mi risk is 37%
do stress test to see if need for cardiac cath before procedure!
