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24 Principles of Anesthesia II > SCIP & ERAS (Exam II) > Flashcards

SCIP & ERAS (Exam II) Flashcards

1
Q

Complications lasting 30 days decrease median survival rate by ____%.

A

69%

nice

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2
Q

What are the antibiotic performance metrics associated with the SIP (Surgical Infection Prevention Project)?

A
  • ABX started within 1 hr of incision
  • ABX regimen consistent w/ guidelines
  • ABX d/c within 24hours of surgery stop
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3
Q

What did compliance with three metrics of SIP project look like?

A
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4
Q

When was the Surgical Care Improvement Project (SCIP) implemented?
What was the intended result?

A
  1. Aimed at reducing surgical mortality and morbidity.
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5
Q

What national organization was notably missing from the SCIP steering committee?

A

AANA

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6
Q

What are the three antibiotic measures associated with the SCIP?

A
  1. ABX within 1 hour of incision
  2. Correct ABX based on procedure
  3. D/C ABX in 24 hours unless documented reason.
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7
Q

What are the two antibiotics that can be given within 2 hours of incision?

A

Vancomycin and Fluoroquinolones

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8
Q

When must ABX be discontinued after Cardiac Surgery?

A

Within 48 hours of cardiac surgery

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9
Q

What are the β-blocker measures associated with the SCIP?

A
  • β blocker within 24 hours of surgery start for all patients on chronic β blocker therapy.
  • β blocker restarted after surgery for all patients on chronic β blocker therapy.
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10
Q

What is the hair removal measure associated with the SCIP?

A
  • Documentation of appropriate hair removal w/ clippers only (no razors).
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11
Q

What is the foley catheter measure associated with the SCIP?

A

Urinary catheter removal on or before POD 2 unless order for extension exists.

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12
Q

What is the blood sugar measure associated with the SCIP?

A

Cardiac patients need a controlled post-operative blood glucose of ≤ 200 mg/dL prior to surgery and after.

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13
Q

What are the DVT measures associated with the SCIP?

A
  • SCDs placed for all surgeries unless under 1 hour.
  • Orders for DVT prophylaxis on post-operative admission orders.
  • RN administration of DVT prophylaxis within 24 hours of surgery end.
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14
Q

What are the temperature measures associated with the SCIP?

A
  • Normothermic or active warming in OR
  • 1st temp in PACU ≥ 96.8F within 15 minutes of leaving OR.
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15
Q

What are the new ASA guidelines for preoperative fasting?

A
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16
Q

What pre-medications are typically given in the pre-operative area?

A

Midazolam (and/or fentanyl)
COX-2 Inhibitor (Paracoxib, celecoxib, etc)

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17
Q

A 70kg patient was NPO for 8 hours. What is this patients calculated fluid deficit?

A

40ml + 20mL + 50mL = 110mL/hr

110 x 8hrs = 880 mL deficit

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18
Q

How much of a fluid deficit occurs due to bowel prep?

A

2-3L

19
Q

What type of insensible losses might be seen in a patient?

A

4-8 mL/kg/hr

This doesn’t pass the sniff test. For a 50kg patient this would be 2400 mL per day on the low end.

20
Q

What drugs are used for intraoperative pain management?

A
  • Opioids
  • Local LA infiltration by surgeon
  • Epidural
  • Ketorolac
  • Dexmedetomidine
  • Ketamine
21
Q

What benefits do opioids provide for intraoperative pain control?

A

Cardiovascular stability

22
Q

What risks are associated with Ketorolac (Toradol) use?

A

Bleeding & kidney injury

23
Q

What is the intraoperative dose of ketamine?

A

0.25 - 0.3 mg/kg

24
Q

What are risk factors for PONV?

A
  • Female gender
  • Non-smoker
  • Young
  • Duration of anesthesia
  • Post-operative opioid use
  • Hx of PONV or motion sickness
25
Q

What are the top two “things” that patients don’t want to experience after surgery?

A

Vomiting
ETT gagging

26
Q

What is the PONV guideline?

A
27
Q

What are timeframes for the three phases of care?

A
28
Q

What are the preoperative “Must-Haves” of the ERAS Protocol?

A
  • Formal pre-surgical patient education and counseling
  • Risk assessment w/ standardized optimization
29
Q

What are the intraoperative “Must-Haves” of the ERAS Protocol?

A
  • Limited fasting
  • Carb-rich drink 2 hours prior to cut
  • Opioid sparing-multimodal analgesia continuing through discharge.
30
Q

What are the postoperative “Must-Haves” of the ERAS Protocol?

A
  • Ambulation within 8 hours of surgery stop time
  • Formal discharge education (incision and mobility specifically)
  • Continuation of opioid-sparing multimodal analgesia
31
Q

Can patient education vary from surgeon to surgeon according to the ERAS protocol?

A

No.

32
Q

What are the suggested intraoperative interventions of the ERAS protocol? (not the must-haves).

A
  • No foley unless sx > 4 hours
  • Minimize blood loss
  • Normovolemic, -thermic, -glycemic
  • PONV prevention
  • Foley out in PACU
33
Q

What are the effects of surgical stress and NPO status on metabolism?

A

↓ glucose uptake
↑ insulin resistance
↑ gluconeogenesis
↑ catecholamines
↑ cortisol
↑ Cortisol
↑ Immunosuppression
↑ Interleukins (1 & 6)
↑ Post-operative lean tissue loss

34
Q

What benefits does CHO (carbohydrate) loading prior to surgery provide?

A
  • ↓ insulin resistance
  • ↑ patient comfort
  • No aspiration events
  • No data on muscle retention
35
Q

What are the suggested post-operative interventions of the ERAS protocol? (not the must-haves).

A
  • Early nutrition
  • Post-discharge call to patient within 1 week (pain, concerns, incision status, instructions)
  • Post-discharge office visit within 14 days
36
Q

What crystalloid should be avoided if possible in goal directed fluid therapy?

A

NS

37
Q

What are the benefits of not doing a bowel prep?

A
  • Earlier return of bowel function
  • Shorter hospital stay
  • No difference in rate of anastomotic leaks or wound infections.
38
Q

What type of analgesia techniques are preferred over PRN opioids?

A
  • PCA
  • Regional LA
  • Neuraxial
39
Q

What drugs reduce opioid requirements by 20-30%?

A
  • COX-2 Inhibitors
  • NSAIDs
  • Acetaminophen
40
Q

What drug is useful for treating opioid resistant pain?

A

Ketamine

41
Q

What drugs reduce overall anesthetic drug requirements?

A

α-2 agonists (clonidine, dexmedetomidine)

42
Q

What is the flowchart for PONV prophylaxis?

A
43
Q

What might a ERAS pain management protocol look like?

A
44
Q

Mg⁺⁺ may potentiate ________ drugs thus leading to increased skeletal muscle relaxation.

A

Neuromuscular blocking

24 Principles of Anesthesia II (23 decks)

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