Putting It All Together Flashcards
t/f, preop assessment must be done by anesthesia provider
true
What 2 interviewing techniques are most important
Active listening
Empathetic responses
Name some goals of preop assessment
-optimize care
-minimize periop M&M
-minimize surgery delays
-Determine post op disposition
-evaluate health status
-optimize preop condition
-Formulate a plan
-communicate w/ team
-communicate w/ pt
-educate
-efficiency
Primary goal for preop interview
listen & improve pt well being via trusting/supportive relationship
FIFE acronym
F-feelings
I-ideas
F-function
E-expectations
The pinnacle of patient-centered care is ______ _______ ________
shared decision making
ASA PS ____
A normal healthy patient
Healthy, nonsmoking, no or minimal alcohol use
PS 1
ASA PS ___
A patient with mild systemic disease
Mild diseases only without substantive functional limitations.
Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease
PS 2
ASA PS ___
A patient with severe systemic disease
Substantive functional limitations; one or more moderate to severe diseases.
Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥ 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents
PS 3
A patient with severe systemic disease that is a constant threat to life
Examples include (but not limited to): recent (< 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
PS 4
ASA PS ___
A moribund patient who is not expected to survive without the operation
Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
PS 5
ASA PS ___
A declared brain-dead patient whose organs are being removed for donor purposes
PS 6
ESRD not going to dialysis. What PS class?
PS 4
ESRD going to dialysis. What PS class
PS 3
ASA PS ___
emergency
PS E
What class procedure is highly invasive and may require blood tx, invasive monitors, or post op ICU
Class C procedure
Routine lab test preop?
NO
What type of analgesia/anesthesia improves all outcomes related to preventative pain management
Epidural
Aka pre-emptive analgesia
Preventative analgesia
List some risk factors for PONV
-female
-hx of PONV
-non-smoker
-<50yo
-surg >3hrs
-opioid use
-volatile anesthetics
-reversal agents
-abd surg
-gynecologic/breast surgery
-laparoscopic surg
What med can you NOT GIVE w/ parkinson’s and GI obstruction
Reglan (&N2O)
What PONV med do you have to worry about sedation effects (up to 12hrs)
Droperidol
Intraop hypercarbia, tachycardia, elevated temp, muscle rigidity, metabolic acidosis, rhabdo, hyperk+ arrythmias
***d/t uncontrolled elevation of intracellular Ca++ d/t ryanodine receptor mutation
Malignant hyperthermia (MH)
MH triggering agents
-volatile agents
-SCh
-heat exposure
What receptor is mutated in MH patients
Ryanodine
MH tx.
Dantroline 10mg/kg
(reconsituted w/ sterile water)
Will all MH suseptible pts display symptoms after exposure to trigger agent?
NO
Key w/ MH
Identify pts at risk
Pseudocholinesterase deficiency pts have a hard time metabolizing what 5 drugs?
-SCh
-Mivacurium
-ester LA
-remifentanil
-heroin
What does the dibucaine # indicate
% inhibition of pseudocholinesterase
What 2 genotypes and dibucaine #s are relatively mild forms of pseudocholinesterase deficiencies?
W-W, #80 (10 minutes)
W-A, #60 (20-30 minutes)
What genotype and dibucaine # is severe and requires postop ventilation?
A-A, #20 (8 hours!!)
