Quiz 1 Flashcards
Risks of anesthesia
- Decreased systemic vascular resistance
- Decreased stroke volume
- Induction of general anesthesia lowers systemic arterial pressures by 20-30%, tracheal intubation increases the blood pressure by 20-30 mm Hg, and many anesthetic agents lower cardiac output by 15%
High risk surgeries?
- vascular procedures-
- prolonged, complicated
- thoracic, abdominal
- head and neck procedures
does the presence of anemia place the patient at higher perioperative risk?
yes
Risk factors:
- presence of CAD and CHF
- a history of cerebrovascular disease
- preoperative elevated creatinine greater than 2 mg per deciliter
- insulin treatment for diabetes mellitus
- high-risk surgery
Eval of cardiac risk:
- Risk factors (Age (but not alone), HTN, DM, Lipids, Tobacco)
- Angina
- Previous MI
- Dysrhythmias
- associated CVS disease (Aortic, Carotid, Renal)
- valvular disease
- presence of pacer/AICD
displaced apical pulse means?
cardiomegaly
s3 gallop means
increased LVEDP
S4 means?
decreased compliance
One MET represents the oxygen consumption of a resting adult, which is?
3.5 ml/kg/min
If patients reduce exertion because of cardiac symptoms but still meet a 4-MET threshold, clinicians will _________ risk
underestimate
Examples of 4 METS activities?
- light work like dusting or doing dishes
- climb a flight of stairs or walk uphill
- walk level at 4mph
- Run a short distance
- heavy work like scrubbing floors or moving furniture
- golf, bowling, tennis, dancing, playing catch
What heart blocks require further testing?
- block greater than 1st degree
- LBBB
Major clinical predictors of periop CV risk
- Unstable Coronary Syndromes (acute or recent MI, severe or unstable angina)
- Decompensated Heart Failure
- Significant Arrhythmias
- Severe Valvular Disease
intermediate clinical predictors of periop CV risk
- Mild Angina
- History of MI, Pathologic Q’s
- Compensated or Prior CHF
- Diabetes Mellitus (controlled/uncontrolled)
- Renal Insufficiency (CKD)
Minor clinical predictors of periop CV risk
- Advanced age
- Abnormal ECG (LVH,LBBB, ST-T abnormalities),
- Rhythm other than sinus (e.g. AF)
- Low functional capacity (e.g., inability to climb one flight of stairs)
- History of stroke
- Uncontrolled systemic hypertension
Risk percentages
High risk - >5%
Intermediate risk - 1-5%
Minor risk - < 1%
Reasons to do non-invasive testing prior to surgery?
- <4 METs
- High surgical risk procedure
Look at slide 35
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