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Basic Sciences > Preoperative Evaluation and Management > Flashcards

Preoperative Evaluation and Management Flashcards

1
Q

What questions should you ask yourself?

A

Does it make sense physiologically?
Is it based on evidence and/or consensus based guidelines?
Will it affect the procedure type, anesthetic choice or outcome?
Will it prevent a delay or cancellation?

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2
Q

What to look for Peop Evaluation of the Airway?

A 
Teeth-large, loose, overbite
Jaw mobility-ant/post, size
mouth opening- obvious, why
mallampate-Low PPV
mandibular compliance-radiation, mass
thyromental distance-3 fingerbreaths
Neck-size, short, thick, immobile
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3
Q

ASA classification I?

A

Normal, healthy patient

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4
Q

ASA classification II?

A

Mild systemic disease

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5
Q

ASA classification III?

A

Severe, not incapacitating systemic disease

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6
Q

ASA classification IV?

A

Incapacitating disease that is a constant threat to life

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7
Q

ASA classification V?

A

Moribund pt. not expected to survive 24 hrs regardless of surgery

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8
Q

ASA E classification

A

Suffex added to class, any pt in whom an emergency operation is required

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9
Q

What do you look for in Preop Eval of the Pulmonary system?

A

Patient related factors - age (>60, >70), COPD (other lung dz), smoking, CHF, functional dependence, cognitive impairment, ASA classification, Obesity?, OSA?
Procedure related factors - site (most important), type, duration, anesthetic technique?, emergency surgery?

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10
Q

What would look for an Pulmonary physical?

A

decreased breath sounds during auscultations, assess respiratory rate, use of accessory muscles, nail color, METs, upper respiratory infection, stridor, SOB, cough, tobacco use, OSA

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11
Q

What do you see in an Airway classification !? (Mallampati and Grade after intubation)

A

Mallampati - soft palate, fauces, uvula, pillars

Grade - entire cords

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12
Q

Airway classification II?

A

Mallampati - soft palate, fauces, uvula

Grade - half the cords

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13
Q

Airway classification III?

A

Mallampati - soft palate, uvualar base

Grade - tip of epiglottis

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14
Q

Airway classification IV?

A

Mallampati - hard palate only

Grade - no glottal structures

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15
Q

What Pulmonary test will be performed?

A

CXR (you can have a baseline), Sprometry/PFT’s (only for lung dzs), BUN > 21, Serum Albumin<3.5

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16
Q

What are some strategies to reduce pulmonary post op complications?

A

stop smoking, lung expansion modalities, NMBA’s and residual blockade, newroaxial techniques, nutritional support, NG tube and PAC

17
Q

How to evaluate OSA?

A

STOP BANG
Snoring, Tired, OSA, blood Pressure (high), BMI>35, Age>50, Neck >40cm, Gender (male)
CPAP available?

18
Q

Peop Evaluation for Cardiac?

A

AHA guidelines - active cardiac conditions, clinical risk factors, other minor clinical predictors, type of surgery, exertional capacity

19
Q

What would be considered active cardiac conditions?

A

Unstable coronary syndromes (angina), Decompensated HF (worsening or new onset), Significant arrhythmias (AV block, a-fib, v-tach, brady), Severe valvular disease (aortic or mitral stenosis)

20
Q

What do you look for in a cardiac history?

A

ischemic heart disease, CHF, CVD, Diabetes Mellitus, REnal Insufficiency

21
Q

What would be considered MET 1?

A

take care of yourself?
eat, dress, or use the toilet?
walk indoors around the house?
walk a block or 2 on level ground at 2 to 3 mph?

22
Q

MET 4?

A

do light work around the house like dusting or wash dishes?

climb a flight of stairs or walk up a hill?

23
Q

MET >10?

A

participate in strenuous sports like swimming, singles tennis, football, basketball or skiing

24
Q

What do you look at in an Electrocardiogram?

A

Significant findings - arrhythmias, Q waves, LVH with strain pattern, ischemia
Less significant - ST changes, BBB, poor R wave progression

25
Q

what to look at during a stress test?

A

Stressors/ Vasodilators (treadmill, dobutamine, DP), Test (EKG, echo, nuclear scan), coronary calcium scoring, CT coronary angiography, Catheterization

26
Q

What to ask when the patient has a stent?

A 
Bare metal, drug eluting, type
Date, location, difficulty
Size, overlap, h/o previous thrombosis
Patient's comorbidities, including CAD
antiplatelet therapy
risk of thrombosis vs surgical bleeding
27
Q

What other major comorbidities to consider?

A

DM - control BS 140-180, HgbA1C<9, pump
thyroid - make euthyroid
Renal Disease - baseline
All other - not much direct intervention

28
Q

What other testing to look for?

A

CBC, Diff, Chem basic, Chem comp, Coagulation studies, UA and culture, Pregnancy testing

29
Q

What minor questions to as in the Preop?

A

Medication management, NPO, aspiration, SBE prophylaxis, Preop Medication Goals

30
Q

What to ask and look for in preop medication management?

A

In the last 7 days - Flavix, NSAIDS?, Herbals, Chemo
Coumadin - 5days
NIght Before - oral hypoglycemic agents, long acting insulin, parkinson’s meds
Morning of - stimulants, ACEI, ARBs, Diuretics

31
Q

Medications we should give for preop management?

A 
Cardiac - antiarrhythmics, angina drugs
Pulm - inhalers, nebs, po meds
Endo - steroids, synthroid
GI - PPIs, H2 blocks
Psych meds
Statins and beta blockers
Seizure meds
Eye drops, pain meds, transplant meds
32
Q

Recommendations of statins in Class I patients?

A

for pts currently taking statins and scheduled for non cardiac surgery, statins should be continued

33
Q

Recommendations of statins in Class IIa patients?

A

For patients undergoing vascular surgery with or without clinical risk factors, statin use is reasonable

34
Q

Recommendations of statins in Class IIb patients?

A

For patients with at least 1 clinical risk factor who are undergoing intermediate-risk procedures, statins may be considered

35
Q

What Herbals affect platelet function and inhibit clotting?

A

Affect platelet function - bilberyy, bromelain, don quoi, feverfew, fish oil, flax seed oil, garlic, ginger, ginko biloba, grape seed extract, saw palmetto
Inhibit clotting - chamomile, dandelion root, dong quoi, horse chesnut, chonroitin

36
Q

What are the NPO guidelines?

A

Clear liquids - 2 hrs
Breast Milk - 4 hrs
Formula, light meal, other milk - 6 hrs
Solid Food - 8 hrs or more

37
Q

What other problems can herbals cause?

A

worsen inflammation post op
prolong anesthesia - kava kava, st johns wort, valerian garlic
Cause post-op HTN - ephedra, ginseng, licorice, goldenseal, garlic
Drug interaction - SJW, ephedra, echinacea, goldenseal, licorice, valerian, bromelain
Evening primrose oil can cause seizures

38
Q

What are the Peop medication goals?

A 
Anxiolysis, sedation
Amnesia, analgesia
Drying of secretion - glyco vs scop
Blunting autonomic relfexes
Reduce anesthetic requirements 
Facilitate smooth induction
Antiemetics, reduction of gastric stuff

Basic Sciences (1 decks)

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