Surgery: Pre-op Flashcards
important pre-op history: allergies
Prior anesthesia experience and responses to anesthetics
what patients need Chest Xray before any surgery ?
All patients older than 60 and/or significant pulmonary or cardiac history
*Abnormalities on CXR must be worked up prior to surgery.
who needs pre-op EKG? what does an abnormal result need?
if age > 40 or other major comorbidities
*Abnormal EKG warrants a Cardiology consult or stress test.- BEFORE surgery
a “silent” MI, detected on pre-op EKG, are most common in what two pt populations
elderly and diabetics.
two “blood type” tests for pre-op: type and cross vs type and screen
Type and screen: for routine, unlikely needing transfusion surgery
Type and Cross: specify # units that may be required during surgery (at least 2 units)
what lab value is ALWAYS a trigger for further evaluation and/or possible postponement of surgery? (KNOW)
low platelet count
what two pieces of info does BMP/CMP provide for pre-op?
Provides baseline electrolyte levels ( K+ and Na+ ) as well as BUN/Cr to determine renal function
what info does PT/INR provide for pre-op? PTT? KNOW
necessary if on warfarin or liver dysfunction; heparin
why do we do a pre-op UA?
Can identify UTI/hematuria
Any urinary infection should be treated prior to surgery, especially if a prosthesis of any kind is going to be implanted (EVEN ASYMPTOMATIC)
what is “detskys modified cardiac risk assessment”?
assigns points for certain pt history
-chances for MI for those with cardiac issues if they get operation
Class I 0-15 (low risk ) to Class III 31 +(high risk )
what are the most common cause of post-operative morbidity? what surgery increases these chances? KNOW
Post-operative pulmonary complications
*anytime there is surgery around muscles/structures around the lungs (associated with diminished residual capacity)
Smokers are at a ___to ___times greater risk for pulmonary complications.
2-6 times greater
American Society of Anesthesiologists Physical Status Classification
KNOW
Class 1: Healthy patient, no medical problems.
Class 2: Mild systemic disease
Class 3: Severe systemic disease, but not incapacitating
Class 4: Severe systemic disease that is a constant threat to life
Class 5: Moribund, not expected to live 24 hours regardless of
operation
assessment of coagulation status: PT/INR (KNOW)
measures the extrinsic pathway of coagulation
- determines the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status.
normal INR range
INR is 0.8–1.2
assessment of coagulation status: PTT (KNOW)
indicator measuring the efficacy of the intrinsic
-determines treatment effects with heparin.
normal Ptt range
35-45
4 reasons renal function needs to be tested for preop?
- Baseline renal function tests ( BUN/Cr/GFR )
- Avoid hypotension
- Adjust nephrotoxic drugs based upon renal function
- Attention to electrolyte status: K+, Mg+, Phos.
5) . modification of hemodialysis
three reasons liver dysfunction needs to be evaluated for preop?
1) . Platelet dysfunction
2) . Medication metabolism can be effected
3) . Vitamin and mineral deficience
4) . decrease in sodium excretion
3 reasons DM needs to be evaluated for preop?
- Increased risk of hyper/hypoglycemia and infection (if uncontrolled)
- obtain euglycemia
- DM pts may have 2-4 times the risk of CV mortality
patients with previously uncontrolled DM with oral agents may require what prior to surgery?
insulin
DM NPO patients should do what to their dose of insulin the morning of surgery?
NPO patients should reduce their morning dose of insulin to one-half of the usual dose
5 preop orders (KNOW)
- NPO past Midnight : need 8 hours for reduction in aspiration risk
- Antibiotics on call to OR: Should be given within 30 minutes of the incision
- Medications: Can they take AM meds with sip of water?
- Void on call to OR: Catheter usually placed once in OR suite
- Hospitalization or outpatient procedure
5 ways you can prevent infection prior to surgery? (KNOW)
- Use of broad spectrum cephalosporin (cover for Staph- most common infection)
- Removal of hair
- Eradicate dead spaces - suture them up
- Operative time ideally < 2 hrs. (above this, chances of infection increase)
- Closed system drainage away from the incision site
two tx used to prevent DVT/PE post surgery?
- lovenox (LMW heparin) or heparin
2. EARLY AMBULATION
what is virchow’s triad?
increases risk of Thrombosis:
1) vascular injury
2) . hemostasis
3) . hypercoagulability
what test to determine adequacy of nutrition prior to procedure?
Prealbumin
what 3 complications can poor nutrition/malnutrition cause for surgery?
Causes poor wound healing, poor bone growth and overall increases chances of post-operative complications.
Much higher risk of what two things if MI within previous 30 days?
morbidity and mortality
preop glucose control should be in what range?
100-150
things that need to be investigated prior to surgery (6) KNOW
1) . abnormal labs: CBC, renal or liver dysfunction, LOW platelet count
2) . DM (uncontrolled)
3) . abnormal UA/UTI
4) . pneumonia/ lung problems
5) . EKG abnormalities
6) . CXR abnormalities
how do you properly consent a patient? KNOW
CONVERSATION
