Quiz 1 Part 2 - Harold's Portion Flashcards
What is visualized with Mallampati 1?
- Soft Palate
- Fauces Uvula
- Pillars
What is visualized with Mallampati 2?
- Soft Palate
- Fauces Uvula
What is visualized with Mallampati 3?
- Soft Palate
- Uvular Base
What is visualized with Mallampati 4?
-Hard Palate
What is visualized with Cormack Grade 1?
Glottis is fully visualized. (Entire glottis)
What is visualized with Cormack Grade 2?
Landmarks are identifiable, but laryngeal aperture is partially obscured. (Posterior Commissure)
What is visualized with Cormack Grade 3?
Laryngeal aperture is almost completely obscured. (Tip of epiglottis)
What is visualized with Cormack Grade 4?
Unable to visualize the laryngeal aperture. (No glottal structures)
An extremely loose tooth may be extracted before laryngoscopy to prevent its aspiration during anesthesia?
True
It is not necessary to properly document dentition because patient assumes all risk?
False
What is the thyromental distance?
- Straight distance with neck fully extended and mouth closed between prominence of the thyroid cartilage and the bony point of the lower mandibular border.
- Normal adult thyromental distance >= 7 cm.
What is interincisor distance?
- Degree of the mouth opening (Top incisor to lower incisor).
- normal gap in adult is 4.6 cm or more
What is the Atlantooccipital Extension (AO) of head and neck?
Aligns the oral, pharyngeal, and laryngeal axes into the sniff position (McGill).
What is mandibular mobility?
Ability to move the jaw forward and bite their upper lip.
List the pulmonary complication?
- Atelectasis
- Pneumonia
- Aspiration Pneumonia
- Bronchitis
- Bronchospasm
- Hypoxemia
- Exacerbation of COPD
- Respiratory failure requiring mechanical ventilation.
What is the length of surgical time that will lead to increased risk of pulmonary complication?
Greater than 2 to 3 hours.
The prophylaxis for asthmatic patients are?
- Systemic steroid coverage of 100 mg Hydrocortisone IV q 8 hours
- Use of personal bronchodilator immediately pre-induction
What are the risk factors for a smoker?
- increased carboxyhemoglobin levels, sputum production, and peri-operative airway reactivity
- decreased ciliary function and stimulation of cardiac system from nicotine.
What is obstructive sleep apnea?
-Syndrome defined by periodic obstriction fo the upper airway during sleep
-Episodic oxygen desaturation and hypercarbia
-Found in 9% women and 24% of men
Physical charecteristics
-obese with BMI >35 kg/m^2
-increased neck circumference
-severe tonsillar hypertrophy
-anatomic abnormalities of upper airway
Anesthesia management of obstructive sleep apnea patient.
- Decrease use of narcotic
- Regional anesthesia preferred
- Use of CPAP post-operatively
- Continuous pulse oximetry
Acute intoxication does what for the anesthetic patient?
- Lowers anesthetic requirements
- Predisposes to hypothermia
- hypoglycemia
Withdrawal does what for the anesthetic patient?
- Hypertension
- increase anesthetic requirements
- Tremors
- Delirium
- Seizures
Stimulant abuse does what for the anesthetic patient?
- Palpitations
- True angina
- Lowered threshold for serious arrhythmia
- Convulsions
What does routine use of Narcotics/Benzodiazepines do to the anesthetic patient?
- Increase the dose to induce anesthesia
- Increase the dose to maintain anesthesia
- Routine use will impact post-op pain requirements
Patient with hypertension associated with LVH places patient at greater risk for what?
Myocardial infarction and cerebral vascular accident.
-WATCH for patient on diuretic use they may have hypovolemia and electrolyte imbalance.
What are the S/S of clinical significant valvular disease?
- Angina
- Syncope
- CHF r/t aortic stenosis
- Mitral Valve Prolapse (MVP) that requires prophylaxis for sub-acute bacterial endocarditis
What is the clinical significance of cardiac arrhythmias?
Ventricular Arrhythmias
- Benign
- Potentially malignant
- Malignant
When do you do an EKG on the anesthetic patient?
-Patient over 40 years old
-New Q waves
-ST-segments depression/elevation
-T-wave inversions
-Rhythm distubances
PVC
A-Fib/A-flutter
LBBB
2nd or 3rd degree AV Block
Assessment of neuro status on a patient should include what?
- Baseline neuro status
- History of increased ICP
- Seizure disorder
- Preexisting neuromuscular disease
- Cranial nerve function
- Cognition
- Peripheral sensory-motoer function
- Preexisting nerve injury
Assessment of endocrine history should include what?
- Diabetes Mellitus
- Thyroid disease
- Parathyroid Disease
- Endocrine-secreting tumors
- Adrenal cortical suppression
What are the microvascular effects of diabetes mellitus?
- Retinopathy
- Neuropathy
- Nephropathy
What are the macrovascualr effects of diabetes mellitus?
- MI
- Stroke
What is the regimen for patients on glucose management the morning of surgery?
Administeration of one fourth to one half the usual daily intermediate acting dose.
What is the cause of hyperthyroidism?
Excess secretion of T3 and T4
What do the s/s reflect in hyperthyroidism?
Hypermetabolic state with sympathetic overactivity resulting from the primary effects of thyroid hormones on the adenylate cyclase system.
What are the associated conditions of hyperthyroidism?
- Graves disease
- Toxic goiter
- Thyroid carcinoma-Pituitary tumors that over secrete thyroid stimulating hormone
The s/s of hyperthyrodism are?
- Anxiety
- Fatigue
- Skeletal muscle weakness
- Tachycardia
- Tachydysrhythmias
- Exophtholmos
What are the preoperative goals for hyperthyroidism?
Consider intraoperative use of beta-blockers
-preoperative labs CBC/platelets
-Euthyroid state
Antithyroid drugs 6 to 8 weeks
Mehimazole or propylthiouracil
Followed by iodine for 1 to 2 weeksWhat associated conditions go along with hypothyroidism?
- Chronic thyroiditis
- Hashimoto disease
Will hypothyroidism delay surgery usually?
NO
What are the S/S of hypothyroidism?
- lethargy
- Intolerance to cold
- Bradycardia
- Decreased
What are the adrenal disorders?
- Pheochromocytoma
- Long term corticosteroid use(Cushing Syndrome)
- Hyperaldosteronism
- Adrenocortical insufficiency (Addison’s Disease?
What are the s/s of pheochromocytoma?
- Paroxysmal hypertension
- Triad of diaphoresis, tachycardia, and headache
- Tremulousness
- Weight loss
- Decreased intravascular fluid volme (orthostatic hypotension) (Hematocrit >45%)
- Cardiomyopathy
- Intracerebral hemorrhage
What are the pre-op preperation for patient’s with adrenocortical dysfunction?
- Correction of fluid and electrolyte disorders
- Treatment of coexisting disorders (HTN)(DM)
- Exogenous corticosteroid therapy
What is the perioperative glucocorticoid supplementatioin for patients receiving chronic corticosteroids?
Hydrocortisone
Does a patient with a past history of gastric bypass receive a NG tube?
NO
Consideration for patients with GERD, small bowel obstruction, N/V, Hx barium swallow?
- At increased risk for pulmonary aspiration
- Rapid sequence induction
What is the description of a physical status classification of a PS-1 by the ASA?
A normal health patient.
What is the description of a physical status classification of a PS-2 by the ASA?
A patient with mild systemic disease that results in no functional limitations.
What is the description of a physical status classification of a PS-3 by the ASA?
A patient with severe systemic disease that results in functional limitations.
What is the description of a physical status classification of a PS-4 by the ASA?
A patient with severe systemic disease that is a constant threat to life.
What is the description of a physical status classification of a PS-5 by the ASA?
A moribund patient who is not expected to survive without the operation.
What is the description of a physical status classification of a PS-6 by the ASA?
A declared brain-dead patientwhose organs are being removed for donor purposes
What is the description of a physical status classification of a E by the ASA?
Any patient in whom an emergency operation is required.
