Review Exam 1 Chapter 19 Flashcards
Patients should be instructed to stop smoking ___ to ___ hours prior to surgery
12 to 48
What patients are at high risk for latex allergies
-Spina Bifida, urologic reconstructive surgery
-more than 9 surgical procedures
-intolerance to latex-based products
-allergy to food (avocado,buckwheat,celery,chesnut) and tropical fruits
-Intraoperative anaphylaxis of uncertain cause
Healthcare professionals esp. those with dermatitis/eczema
Why should patients stop smoking 12-48 hours prior to surgery?
Short term abstinence reduces deleterious effects of nicotine and carbon monoxide on cardiopulmonary function.
How long should a patient stop smoking to reduce their risk of postoperative pulmonary complications?
8 weeks.
What are anesthetic interactions with MAOIs?
- Hypertension with indirect acting sympathomimetics (ephedrine)
- Seizures or hypertensive crisis with meperidine
- Depressive phenomena with opioid administration
What are anesthetic implications of tricyclic antidepressants?
- Alpha blocking activity and potentiation of sympathomimetic effects of epi and norepi
- cardiac arrhythmias
- lower seizure threshold
What are the pharmacologic effects of Echinacea
Activation of cell-mediated immunity
-decreases effects of immunosepressives and may have immunosuppression with long term use
What are the pharmacologic effects of ephedra?
Direct and indirect sympathomimetic effects of HR and BP
- phenylephrine is pressor of choice
- life-threatening interactions with MAOIs
What are the pharmacologic effects of garlic?
Inhibition of platelet aggregation
-stop 7 days preop
What are the pharmacologic effects of ginko
inhibition of platelet function
-stop 36 hrs preop
What are the pharmacologic effects of Ginseng
Lowers blood glucose and inhibition of platelet aggregation
-stop 7 days preop
What are the pharmacologic effects of Kava?
sedation, anxiolysis
- increased sedative effects of anethetics
What are the pharmacologic effects of St. John’s Wort?
- Inhibition of neurotransmitter reuptake
- Induction of cytochrome P450
What are the pharmacologic effects of Valerian?
sedation
What thyromental distance is associated with a difficult airway?
Less than 7cm (less than 3 fingerbreadths)
What degree of mouth opening is associated with a difficult intubation?
less than 4 cm
How do you calculate ideal body weight?
Male: 105 + 6 for each inch >5 ft
Female: 100 + 5 for each inch >5 ft
What is the calculation for BMI?
Weight in kg / (height in meters)²
What BMI is classified as overweight?
25 - 29.9 kg/m²
What BMI is associated with moderate obesity?
30 - 34.9 kg/m²
What BMI is associated with severe obesity?
35 - 39.9 kg/m²
What BMI is associated with morbid obesity?
greater than or equal to 40 kg/m²
What is the gold standard test for diagnosis obstructive sleep apnea?
Polysomnography
When is a patient taking corticosteroids considered at risk for adrenal Insufficency?
- Those who receive the hydrocortisone equivalent of more than 20-30 mg daily for longer than 2 weeks
- Those are who are receiving replacement corticosteroid treatment for adrenal insufficiency
What is the recommended stress dose steroid for minor surgery?
Preop corticosteroid dose + hydrocortisone 25mg or equivalent
What is the recommended stress dose steroid for moderate surgery?
Preoperative corticosteroid dose + hydrocortisone 50-75 mg or equivalent
What is the recommended stress dose steroid for major surgery?
Preoperative corticosteroid dose + hydrocortisone 100-15 mg or equivalent every 8 hr for 48-72 hrs
What should be used at hydrocortisone doses above 100 mg?
Methylprednisolone
4mg of methylprednisolone = 20 mg of hydrocortisone
Patients with a GCS off less than ____ are considered comatose and require intubation
8
What is the range of scores for the glascow coma scale?
3-15
What are the eye opening response scores for the GCS
Spontaneously - 4
To speech - 3
To pain - 2
Never - 1
What are the best motor response scores for the GCS?
Obeys commands - 6 Localizes pain - 5 Withdraws (flexion) - 4 Abnormal flexion (decortication) - 3 Extensor response (decerebration) - 2 None - 1
What is the best verbal response score of the GCS
Oriented - 5 Confused conversation - 4 Inappropriate words - 3 Incomprehensible sounds - 2 None -1
What does 1 MET, 4Mets and >10 METs represent?
1 MET - Poor functional capacity
4 MET - good functional capacity
>10 - excellent functional capacity
What MET level is required to proceed with surgery?
4, provided cardiac risk factors are properly managed with statins and beta blockers.
What is the definition of hypertension?
SBP >140 mmHg or a DBP >90 mmHg
What is Class I cardiovascular disability?
Patients with cardiac disease with no physical limitations
What is Class II cardiovascular disability?
Patients with cardiac disease who are comfortable at rest
What is Class III cardiovascular disability?
Patients with cardiac disease resulting in marked limitations to physical activity
What is Class IV cardiovascular disability?
Cardiac Insufficiency or anginal syndrome even at rest.
What is the risk of reinfarction 6 months post MI, 3-6 months, and 3 months?
6 months: 6%
3-6 months: 15%
3 months: 30%
What is the mortality rate of intraoperative MI?
50%
When is the highest risk of reinfaction post MI?
30 days
What is the recommendation time frame for elective surgery to be postponed after an MI?
4 - 6 weeks
How long should elective surgery be postponed after bare metal stents (BMS) and drug eluting stents (DES)?
BMS - 6 weeks minimum
DES - 12 or more months
Severe aortic stenosis poses the greatest risk when the cross sectional area is less than ____ cm²
1
Dehmlow celebrity question #2:
Severe aortic stenosis is associated with a _____ greater incidence of postop sudden death.
14-fold
-you can thank Dehmlow for that one.
What is the preferred method of cardiac testing?
Exercise stress ECG
What three findings indicate poor ventricular function?
- Cardiac index less than 2.2 L/m²
- LVEDP greater than 18 mmHg
- EF less than 40%
What do areas of akinesis of myocardium represent
- No movement during systole
- Nonviable regions of the myocardium
What do areas of hypokinesis in the myocardium represent?
- Reduced contraction during systole
- Ischemic but viable regions of myocardium
What preop pharmacotherapy is appropriate for patients with up to two clinical risk factors of heart disease?
Statins and Beta blockers
When should patients be started on ACE inhibitors?
If stable LV dysfunction is present
In patients with COPD, when should elective surgery be cancelled?
- severe dyspnea
- wheezing
- pulmonary congestion
- Hypercarbia (PaCO2 >50 mmHg)
Clinical evidence of renal Insufficiency is not apparent until ____ % of nephrons are nonfunctional
70
What is the most accurate test of glomerular filtration?
Creatinine Clearance
Why doesn’t BUN accurately reflect GFR?
Although urea is freely filtered at the glomerulus, it is reabsorbed to a large & variable extent through the tubules. BUN is also affected by amount of protein ingested by GI tract
What is the creatinine clearance equation
GFR = UV/P
*U=urinary concentration of creatinine
*V=volume of urine
P=plasma concentration of creatinine
What is the age of onset for Type 1 & 2 Diabetes?
Type 1: Childhood
Type2: Middle age or elderly
Which type of diabetes has an abrupt onset and which is gradual?
Type 1: abrupt
Type 2: gradual
Which type of diabetes has a higher risk of ketoacidosis?
Type 1
What is Cushing’s syndrome caused by?
Excess levels of circulating glucocorticoid hormones.
What are clinical manifestations of Cushing’s syndrome?
Hypertension Hypovolemia Truncal Obesity Buffalo Hump Moon Face Striae Easy bruising Osteoperosis
What is hyperaldosteronism?
Excess of mineralocortoicoid hormones
What are clinical manifestations of hyperaldosteronism?
Hypertension & Marked Hypokalemia (less than 3 mmol/L)
Intraoperative concerns and management of ACE Inhibitors
Concern: Hypotension with or without bradycardia
Management: Optimize hydration, omit AM dose if possible
Intraoperative concerns and management of calcium channel blockers
Concerns: Decrease SVR and BP, negative inotropy, negative chronotropy
Management: optimize hydration and phenylephrine as needed.
Intraoperative concerns and management of Antiarrythmics
Concerns: Cardiac depression, prolonged NMB, hypotension, atropine resistant bradycardia
How long should NSAIDs be held preop?
At least 1 day.
How long should heparin be DC’d preop?
6 days
How long should coumadin be DC’d preop?
3-5 days
How long should LMWH be DC’d preop?
12 hrs.
