Preoperative Interview Flashcards
What is the goal of the preoperative interview?
to bring the patient back to baseline or better
How you you calculate BMI?
weight in pounds/height in inches^2 x 703
The five A’s of the anesthesia exam include:
allergies, ate (NPO status), previous anesthesia hx., airway, & alert (LOC)
Why do we complete a preoperative interview?
standard 2
develop repoire w/ pt. & devise plan
reduces morbidity and mortality
allows us to optimize patient
Which standard refers to the care plan?
Standard 3
Which standard pertains to the consent?
Standard 4
Students never obtain consent; DO NOT SIGN the consent form as a student
Know the fast-hand method to calculate pounds to kg
patient is 120 pounds
120/2= 60 60-6= 54 kg
Why do we assess for MH & what precautions would we take?
MH is deadly and thus we want to prevent patient from developing; take vaporizers out of room, flush gas machine; patient should be first case of the day; remove succinylcholine from the room
What is OPL?
stands for oral pharyngeal laryngeal and we assess patient’s cervical ROM to see if we will be able to line up our axes
The purpose of the preoperative evaluation is to
evaluate current physical status and optimize the patient for surgery
Goals of the preoperative evaluation is
obtain medical and surgical histories
evaluate the patient and determine the need for preoperative studies or specialty consultations, formulate and deliver safe anesthetic plan, minimize perioperative morbidity and mortality, optimize patient safety and satisfaction, prevent surgical cancellations and delays
AANA’s standard 5
Documentation
AANA’s standard 2
Preanesthesia assessment and evaluation: general health, allergies, medication hx., preexisting conditions, anesthesia history, and relevant diagnostic tests
Included in an preoperative interview is:
verify 2 patient identifiers & verify and document the proposed surgical procedure and preoperative diagnosis
What is the purpose of preoperative interviews?
allows patients to come in within 1-2 weeks prior to surgery to allow for patient optimization, pre-arrange anticipated needs, order appropriate tests and prevent delayed or cancelled surgeries
Essential components of the anesthesia interview include
BMI (height & weight), allergies, NPO instructions, medications, previous anesthetics/complications, family history of MH, possibility of pregnancy, systems review, baseline level of cognition, airway assessment
When asking about allergies it is important to evaluate
allergies to drugs, dyes, contrasts, latex, foods, & tape as well as the reaction (anaphylaxis vs. hypersensitivty)
When asking about previous anesthetics/surgeries, it is important to evaluate:
type of surgery, type of anesthesia, date, complications: PONV, MH, difficult intubation, recall, prolonged wake-up, unplanned postop intubation
also has there been a significant weight gain since previous surgery
Malignant hyperthermia is
an inherited myopathy (autosomal dominant); triggered by volatile anesthetics and depolarizing muscle relaxants leading to–> hypermetabolic state
What does PAGES stand for?
phenylephrine, atropine, glycopyrrolate, edrophonium, and succinylcholine
emergency drugs that must be drawn up
What is the purpose of NPO guidelines?
reduce the risk of aspiration which leads to high incidence of morbidity and mortality
What is aspiration?
accidental inhalation of gastric contents into the lungs–>chemical burn of the tracehobronchial tree and pulmonary parenchyma–> intense parenchymal inflammatory reaction
What are the current NPO guidelines?
2 hours: clear liquid (water, black coffee, tea, pulp-free juice, carbonated beverages)
4 hrs: breast milk
6 hrs: formula or cows milk, tea & coffee with milk, full liquids, light meal, gum, sweets (hard candy)
8 hrs: full meal, fried, or fatty food
What are ways to prevent aspiration?
rapid sequence intubation
crichoid pressure
possibly NG tube
give bicitra (no tums) to neutralize stomach acid
