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N928 Basic Principles of Anesthesia > Preoperative Interview > Flashcards

Preoperative Interview Flashcards

1
Q

What is the goal of the preoperative interview?

A

to bring the patient back to baseline or better

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2
Q

How you you calculate BMI?

A

weight in pounds/height in inches^2 x 703

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3
Q

The five A’s of the anesthesia exam include:

A

allergies, ate (NPO status), previous anesthesia hx., airway, & alert (LOC)

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4
Q

Why do we complete a preoperative interview?

A

standard 2
develop repoire w/ pt. & devise plan
reduces morbidity and mortality
allows us to optimize patient

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5
Q

Which standard refers to the care plan?

A

Standard 3

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6
Q

Which standard pertains to the consent?

A

Standard 4

Students never obtain consent; DO NOT SIGN the consent form as a student

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7
Q

Know the fast-hand method to calculate pounds to kg

patient is 120 pounds

A 
120/2= 60
60-6= 54 kg
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8
Q

Why do we assess for MH & what precautions would we take?

A

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

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9
Q

What is OPL?

A

stands for oral pharyngeal laryngeal and we assess patient’s cervical ROM to see if we will be able to line up our axes

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10
Q

The purpose of the preoperative evaluation is to

A

evaluate current physical status and optimize the patient for surgery

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11
Q

Goals of the preoperative evaluation is

A

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

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12
Q

AANA’s standard 5

A

Documentation

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13
Q

AANA’s standard 2

A

Preanesthesia assessment and evaluation: general health, allergies, medication hx., preexisting conditions, anesthesia history, and relevant diagnostic tests

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14
Q

Included in an preoperative interview is:

A

verify 2 patient identifiers & verify and document the proposed surgical procedure and preoperative diagnosis

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15
Q

What is the purpose of preoperative interviews?

A

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

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16
Q

Essential components of the anesthesia interview include

A

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

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17
Q

When asking about allergies it is important to evaluate

A

allergies to drugs, dyes, contrasts, latex, foods, & tape as well as the reaction (anaphylaxis vs. hypersensitivty)

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18
Q

When asking about previous anesthetics/surgeries, it is important to evaluate:

A

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

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19
Q

Malignant hyperthermia is

A

an inherited myopathy (autosomal dominant); triggered by volatile anesthetics and depolarizing muscle relaxants leading to–> hypermetabolic state

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20
Q

What does PAGES stand for?

A

phenylephrine, atropine, glycopyrrolate, edrophonium, and succinylcholine
emergency drugs that must be drawn up

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21
Q

What is the purpose of NPO guidelines?

A

reduce the risk of aspiration which leads to high incidence of morbidity and mortality

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22
Q

What is aspiration?

A

accidental inhalation of gastric contents into the lungs–>chemical burn of the tracehobronchial tree and pulmonary parenchyma–> intense parenchymal inflammatory reaction

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23
Q

What are the current NPO guidelines?

A

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

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24
Q

What are ways to prevent aspiration?

A

rapid sequence intubation
crichoid pressure
possibly NG tube
give bicitra (no tums) to neutralize stomach acid

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25
Q

Who is most at risk for aspiration?

A

Diabetes, obese, delayed gastric emptying, GERD (uncontrolled), pregnancy after 13 weeks, stroke patients, bowel obstruction, trauma or emergency (SNS engagement)

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26
Q

What is the ideal volume and pH of gastric juices for surgery?

A

<25 mL and pH >2.5

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27
Q

What is Selleck’s Maneuver?

A

holding cricoid cartilage pressure to protect against aspiration

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28
Q

How much force is applied with cricoid pressure?

A

3-4 kg; start at 3 lbs and progress to 6.6-8.8 lbs

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29
Q

Describe the Mallampati classes

A

0: epiglottis, pillars, uvula, soft, and hard palate
1: pillars, uvula, soft & hard palate
2: uvula, soft, & hard palate
3: soft palate & base of uvula
4: hard palate & tongue

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30
Q

What Mallampati class is associated with a difficult intubation?

A

MP 3 or 4

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31
Q

What is Patil’s test?

A

thyromental distance… with the head fully extended measure from the mentum to the thyroid notch
<6 cm associated with difficult intubation; greater than 7 cm is what we want to see
less space for the tongue to be compressed/displaced by the laryngoscope blade

32
Q

What is the upper lip bite test?

A

tells us the patients ability to move maxilla and mandible

limited mouth opening is associated with a more difficult intubation

33
Q

What does the prayer sign assess for?

A

subtle or overt joint contractures which allows us to assess cervical mobility
limited atlanto-occipital joint motion
a positive prayer sign test is bad

34
Q

What does the cervical mobility tell us?

A

decreased cervical mobility prevents proper positioning for intubation (prevents optimal view of the glottic opening)
cannot be placed in ideal sniffing position

35
Q

Dentition assessment is important because

A

we want to return patient to baseline so we need to know decay of teeth, loose teeth, cracks, chips, do you have any teeth that aren’t your own?

36
Q

Important assessment with female patients

A

pregnancy assessment

should be asked in private to maintain patient privacy

37
Q

What could prevent an appropriate mask seal?

A

facial hair;

could also disguise a short thyromental distance or retrognathia

38
Q

What neck circumference is associated with a difficult intubation?

A

BMI > 40 kg/m2 + large neck circumference (>45 cm)

39
Q

Describe the differences between general anesthesia, regional anesthesia, and IV sedation

A

general: total loss of consciousness; does not equal ET tube- could mean mask or LMA
regional: specific to a region of the body
IV sedation: might hear noises but keep them comfortable, sleepy, and breathing on own

40
Q

What medications should be taken prior to surgery?

A

beta-blockers, GERD medications, calcium channel blockers, bronchodilators, antiarrhythmics, steroids, diuretics (if history of CHF), antipsychotics, thyroid medications

41
Q

What medications should be held prior to surgery?

A

oral hypoglycemics, ACE-I, ARBs, diuretics if no hx. of CHF, herbal supplements, per surgeon’s decision- anticoagulants

42
Q

What cardiovascular conditions do we assess during our preop assessment?

A

hypertension, angina, CAD, MI, valvular disease, syncope, CHF, edema, dyspnea, cardiac arrhythmias

43
Q

What respiratory conditions do we assess during our preop assessment?

A

asthma, COPD, recent URIs, emphysema, bronchitis, pneumonia, tuberculosis, obstructive sleep apnea, tobacco use

44
Q

What nervous system conditions do we assess during our preop assessment?

A

stroke, transient ischemic attacks, migraines, headaches, seizures, neuropathy

45
Q

What GI conditions do we assess during our preop assessment?

A

GERD, bowel obstruction/hiatal hernia

46
Q

At what pressure can the lower esophageal sphincter open?

A

the LES can open at 20 cmH2O if manually ventilating

47
Q

What endocrine conditions do we assess for during our preop assessment?

A

diabetes, thyroid

48
Q

Additional preop assessments include:

A

autoimmune (RA, CSpine), musculoskeletal (MS, myasthenia gravis, myopathy, fibromyalgia, myotonias, obesity, Sjogerns syndrome); alcohol & drug use; coagulation or hematologic disorders, hx of malignancy, psychiatric illness, infectious disease

49
Q

What hepatic assessments do we assess for?

A

hepatitis, jaundice, cirrhosis, alcohol

consider coags: PT/PTT, liver panel, and EKG

50
Q

What renal assessments do we perform?

A

RF, ESRD, Dialysis

lab tests: lytes, CBC, PT/PTT, LFT’s and EKG

51
Q

Describe ASA 1

A

normal healthy patient

52
Q

Describe ASA 2

A

mild systemic disease; well-managed diabetes or reflex

53
Q

Describe ASA 3

A

severe systemic disease

54
Q

Describe ASA 4

A

severe systemic disease that is a constant threat to life; dialysis, valve disease

55
Q

Describe ASA 5

A

moribund patient not expected to survive without surgery

56
Q

Describe ASA 6

A

declared brain-dead; anticipating organ procurement (donor)

57
Q

ASA could also have an

A

E status which means emergency

58
Q

Tests for a procedure with blood loss

A

CBC

59
Q

Test to order for patient who is 50-60

A

EKG

60
Q

Test to order for patient >60

A

EKG & CBC

61
Q

Test to order for patient with cardiovascular disease

A

basic chem & EKG

62
Q

Test to order for patient with pulmonary disease

A

EKG

63
Q

Test to order for patient with malignancy

A

CBC & EKG

64
Q

Test to order for patient with radiation therapy

A

CBC & EKG

65
Q

Test to order for patient with hepatic disease or hepatitis history

A

PT/PTT, Liver panel, and EKG

66
Q

Test to order for patient with renal disease

A

PT/PTT, basic chem, and EKG

67
Q

Test to order for patient with bleeding disorder

A

CBC, PT/PTT, Platelet function

68
Q

Test to order for patient with diabetes

A

Basic chem, glucose POC, EKG

69
Q

Test to order for patient who is possibly pregnant

A

pregnancy test

70
Q

Test to order for patient taking diuretic

A

Basic chem

71
Q

Test to order for patient using digoxin

A

Basic chem, EKG, Digoxin level

72
Q

Test to order for patient using long term steroids

A

Basic chem, Glucose POC

73
Q

test to order for pt with CNS disease

A

CBC, basic chem, POC glucose, EKG

74
Q

Test to order for pt with coumadin therapy

A

PT/PTT

75
Q

Test to order for pt with recent pna (w/in two months)

A

CXR

76
Q

Tests to order for patient with RA or down’s syndrome

A

Flexion, extension C-spine films

N928 Basic Principles of Anesthesia (16 decks)

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