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SRNA4TopicsAnesthesia > VALLEY: PREOP/ASSESSMENT > Flashcards

VALLEY: PREOP/ASSESSMENT Flashcards

1
Q

NPO status is determined from what two ?

A

From midnight to surgery.

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2
Q

What is the BEST indicator of fluid status in the patient who has been NPO for 24 hours?

A

Urine output. Oliguria suggests the presence of hypovolemia

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3
Q

Define “MET’

A

A MET is a Metabolic EquivalenT and is defined as the amount of oxygen consumed while sitting at rest. MET are used to evaluate functional capacity and reserve.

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4
Q

A standard MET is equal to

A

3.5 mL 02/kg/min

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5
Q

Metabolic equivalents (METs) range from

A

1 to I2

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6
Q

Determine MET: eating, working at a computer, or dressing.

A

One metabolic equivalent ( 1 MET)

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7
Q

Determine MET walking down stairs, walking in your house, or cooking.

A

Metabolic equivalents (2 METs) is equal to

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8
Q

MET: Walking one or two blocks on level ground.

A

3 METs

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9
Q

MET: Raking leaves or gardening is

equivalent to

A

4 METs.

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10
Q

Climbing one flight of stairs, bicycling or dancing. MET

A

Five metabolic equivalents (5 METs}

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11
Q

Playing golf or carrying golf clubs. MET

A

Six metabolic equivalents ( 6 METs) is equal

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12
Q

Correlates to playing singles tennis. MET

A

7 METs

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13
Q

Rapidly climbing stairs or slowly jogging is equivalent to

A

8 METs.

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14
Q

Jumping rope slowly or moderate cycling.

A

Nine metabolic equivalents (9 METs) c

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15
Q

Swimming quickly, running or jogging briskly. equivalent to 12 METs.

A

(10 METs)

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16
Q

Running rapidly for moderate to long distances

is equivalent to

A

12 METs.

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17
Q

Coss country skiing or playing full court basketball.

A

11 METS

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18
Q

How can temporomandibular joint mobility be evaluated?

A

Temporomandibular joint mobility is best evaluated by having the patient open his/her mouth as wide as possible.

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19
Q

What is the usual cause of temporomandibular joint

immobility?

A

Arthritis is the usual cause of tern- •

poromandibular joint immobility

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20
Q

How wide should the adult be able to open his/her mouth?

A

The adult should be able to open his/her mouth so that there is a 40 mm distance (two large fingerbreadths) between upper and lower incisors.

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21
Q

Temporomandibular joint mobility may be assessed by measuring how far the mouth can be opened. What does this evaluate?

A

The motion of the condylar heads.

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22
Q

Measuring the distance from the anterior mandible to the thyroid cartilage tells you what?

A

This measurement, which is normally 6.5 cm or more in adults, helps preoperatively to assess the probable ease of tracheal intubation. If this distance is less than 6 cm, it will be impossible to visualize the larynx.

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23
Q

Why is the distance from the lower border of the mandible to the thyroid cartilage assessed with finger breadth
preoperatively?

A

If the distance from the lower border of the mandible to the thyroid notch with the neck fully extended is less than 3-4 finger breadths, one may have difficulty visualizing the glottis.

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24
Q

The Mallampati airway classification is based on what assumption?

A

The Mallampati classification is based on the assumption that when the base of the tongue is disproportionately large, the tongue overshadows the larynx, resulting in difficult exposure of the larynx during laryngoscopy

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25
Q

To assess the patient’s Mallampati classification, what do you have the patient do?

A

With the patient sitting and with the head in the neutral position, you ask the patient to open his/her mouth as wide as possible and stick out his/her tongue as far as possible.

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26
Q

Describe the Mallampati classification based on the visibility of these structures: soft palate, fauces, uvula, and
anterior & posterior tonsillar pillars.

A

The structures seen in each Mallampati classification are as follows. Mallampati I: soft palate, fauces, uvula, anterior & posterior tonsillar pillars. Mallampati II: soft palate, fauces, uvula. Mallampati III: soft palate, base of uvula. Mallampati IV: hard palate only. MNEMONIC PUSH

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27
Q

During airway evaluation, only the soft palate is seen during the «mouth fully opened, tongue protruded, no phona· tion” maneuver. What is the Mallampati
classification of this patient?

A

When only the soft palate is seen on evaluation, the patient is a Mallampati class Ill.

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28
Q

How can the anesthetist evaluate the airway preoperatively for potential difficulties of oral endotracheal intubation?

A

Perform the Mallampati classification, evaluate the thyromental (“mental” = chin) distance (the distance between the lower border of the mandible and the thyroid notch is normally greater than 6.5 cm in the adult), evaluate the mobility of the temporomandibular joints, observe the profile of the head and neck from the front and from the side and observe ability to attain the sniffing position.

29
Q

During the preoperative evaluation, a thyromental (chin-to-thyroid notch) distance of 2 fingerbreadths is noted.
What is the anesthetic concern?

A

A thyromental {chin-to-thyroid notch) distance of 3 fingerbreadths or less indicates a probable difficult airway. A short thyromental distance may be due to a receding mandible or a short, muscular neck; it may be difficult to
align the laryngeal and pharyngeal axes in a straight line with a short thyromental distance.

30
Q

What thyromental {chin-to-thyroid notch) distance (in centimeters) indicates a probable difficult airway?

A

A thyromental distance of S 6 cm indicates a probable difficult airway

31
Q

How is the Allen’s test performed?

A

Allen’s test is performed by simultaneously occluding the radial and ulnar arteries, and asking the patient to make a tight fist (forcing blood from the hand, causing the palmar surface to become blanched and pale). Pressure over the ulnar artery is released, and the patient opens his or her hand.

32
Q

What does Allen’s test assess? What isthe meaning of a positive response to the Allen’s test?

A

Allen’s test assesses the adequacy of collateral flow from the ulnar artery. Return of color to the hand within 5- 15 seconds is a positive Allen’s test and indicates there is adequate blood flow to the hand.

33
Q

What is the meaning of a negative response to the Allen’s test? What is the significance of a negative Allen’s test?

A

If flow is inadequate for 15 seconds or longer after the patient opens his/ her hand, there is inadequate collateral ulnar arterial blood flow; a negative Allen’s test is a relative contraindication to insertion of a catheter into the
radial artery.

34
Q

Has Allen’s test been shown to be of value in assessing the adequacy of ulnar collateral circulation?

A

No, it has not.

35
Q

How do you calculate body mass index (BMI)? Calculate body mass index for the patient who weighs 70 kg and is 1.8 meters tall.

A

Body mass index (BMI) is weight in kilograms divided by height in meters
squared. For the patient with weight and height of70 kg and l.8 m, respectively,
BMI = 70 kg/(l.8m x I.Sm) = 70 kg/3.24 m2 = 21.6 kg/m2

36
Q

The preoperative evaluation of the patient reveals no organic, physiologic, biochemical, or psychiatric disturbances. What ASA classification is this patient?

A

ASA Class I: healthy patient.

37
Q

Define the physical status index “ASA PS class 6.”

A

A declared brain-dead patient whose organs are being removed for donor purposes is defined as ASA PS class 6 {“PS” is “Physical Status”).

38
Q

During the preoperative assessment, the patient mentions they had a myocardial infarction last year. What ASA Class is this patient? State five pathophysiologic disturbances consistent with this classification.

A

The patient with a history of myocardial infarction is ASA Class III. Any severe systemic disturbance that limits activity, such as cardiovascular or pulmonary disease, poorly con-trolled essential hypertension, diabetes
mellitus with vascular complications, angina pectoris, or history of myocardial infarction warrants an ASA Class III status.

39
Q

Describe the ASA Class IV status

A

ASA Class IV is characterized by severe systemic disease that is life-threatening.

40
Q

5 pathophysiologic disturbances consistent with ASA IV classification

A

(1) congestive heart failure; (2) persistent angina pectoris; (3) advanced pulmonary disease; ( 4) advanced renal disease; and, (5) advanced hepatic dysfunction.

41
Q

The preoperative assessment report has the statement: “Moribund patient undergoing surgery as a resuscitative etfort, despite a minimal chance of survival:’ What ASA Class is this patient?

A

The statement: “Moribund patient undergoing surgery as a resuscitative effort, despite a minimal chance of survivar is indicative of an ASA Class V status.

42
Q

uncontrolled hemorrhage from a ruptured abdominal

aortic aneurysm –> ASA

A

ASA 5

43
Q

Describe the ASA Class II status and

A

The ASA Class II patient has mild to moderate systemic disturbance that may not be related to the reason for surgery.

44
Q

List 7 pathophysiologic examples.

A

I) heart disease that slightly limits physical activity;

(2) essential hyper-tension;
(3) diabetes mellitus;
(4) chronic bronchitis;
(5) anemia;
(6) morbid obesity; and,
(7) extremes of age

45
Q

An otherwise healthy 30-year-old woman requires a dilation and curettage for moderate but persistent hemorrhage. Identify her ASA status.

A

An otherwise healthy 30-year-old woman requires a dilation and curettage for moderate but persistent hemorrhage is ASA Class IE. The “E” indicates emergency surgery is required

46
Q

Besides children with spina bifida, what 4 groups of people appear to be at increased risk for latex allergy?

A

I) patients who have had multiple surgical procedures;
(2) healthcare and other personnel with frequent exposure to latex;
(3) atopic individuals with a history of multiple allergies;
( 4) individuals with specific food allergies, namely, a voe a·
dos, bananas, chestnuts, and stone fruits.

47
Q

During the preoperative work-up, the patient states an allergy to soy and soy products. What is the anesthetic concern for this patient?

A

Propofol should be avoided in patients with known soy allergy. Soybean oil is used as a component of propofol emulsion.

48
Q

As a rule of thumb, how long shoul most herbal medicines/supplements be discontinued prior to surgery? One common supplement is the exception to
this rule; name this supplement and its recommended discontinuation interval

A

As a rule of thumb, most herbal medications and supplements should be discontinued for a minimum of two weeks prior to surgery. Note: some sources state to discontinue St. Johns wort and ginseng for 7 days (one
week). The exception to this general rule of thumb is ephedra, which is discontinued for 24-36 hours prior to surgery.

49
Q

Most herbal supplements should be discontinued

7 to 14 days before surgery; which herbal is an exception to this rule?

A

Valerian, a central nervous system depressant may cause a benzodiazepine- like withdrawal when discontinued; if possible intake of valerian should be tapered before a planned anesthetic, rather than discontinued.

50
Q

Identify two best-selling herbal medicines that may cause hypoglycemia

A

Garlic, especially when taken concomitantly with chlorpropamide, may cause hypoglycemia. Ginseng has potential to cause hypoglycemia also, especially if the patient is taking oral hypoglycemics.

51
Q

List the five most undesirable outcomes associated with anesthesia, from the patients point of view.

A

From the patients point of view, the five most undesirable outcomes of anesthesia are (in order) vomiting, gagging on the endotracheal tube, incisional pain, nausea, and recall without pain.

52
Q

From the anesthetists point of view, what are the 2 main goals of premedication of the patient?

A

The primary goals of premedication, from the anesthetists point of view, are alleviation of apprehension and rapid induction of anesthesia

53
Q

What is the most critical factor for detemining heat loss during anesthesia and surgery? Why?

A

Operating room temperature is the most critical factor. Most body heat is lost by radiation and convection from the skin and surgical incisions

54
Q

Identify three reasons for sustaining normothermia during the maintenance phase of anesthesia (assume there is no
reason to provide hypothermia).

A

Normothermia during the maintenance phase of anesthesia ( 1) decreases morbidity (e.g., infection), (2) decreases blood loss, and (3) minimizes postoperative shivering.

55
Q

Most adult patients remain normothermic when operating room temperature is above what value? What ambient ternperatures may be required for infants?

A

23° C is adequate to maintain normothermia in most adults. Infants may require ambient temperatures exceeding 26° C.

56
Q

What is the minimal acceptable operating room temperature compatible with preventing hypothermia in an adult patient?

A

A minimum temperature of 21 ° C helps prevent hypothermia in adults.

57
Q

What is one of the best ways to minimize body heat loss during anesthesia and surgery?

A

Increase operating room temperature

58
Q

In addition to increasing operating room temperature, the anesthetist may use several other techniques to maintain
body temperature. List four such ways to maintain body temperature. Which of these four strategies is most effective?

A

(I) Insulate the body by using reflective coverings such as “space blankets~ “bear huggers·: heating blankets, or plastic bags (insulation reduces body heat loss by radiation and convection);

(2) use infrared warmers (these reduce heat loss from incisions, but may not be tolerated by the surgeon);
(3) warm and humidify inspired gases;
(4) heat intravenous fluids.

59
Q

The best way of maintaining normothermia because

heat loss by radiation and convection is reduced

A

Insulating the body i

60
Q

Insulating the body reduce

A

Heat loss by radiation and convection

61
Q

What is the most effective method to achieve patient warming?

A

The most effective perianesthetic warming system is warm forced air.

62
Q

Padding the patient everywhere prevents heat loss by what routes?

A

Padding serves as insulation and prevents heat loss by convection and radiation

63
Q

Preoperative incentive spirometry teaches the patient to do what two things?

A

Preoperative incentive spirometry is based on teaching the patient to mobilize secretions and to increase lung volume.

64
Q

List three aims of incentive spirometry.

A

Incentive spirometry is aimed at removing secretions, eliminating infection, and reversing bronchospasm

65
Q

What is the overall purpose of incentive spirometry?

A

To increase lung volumes (especially to increase FRC) in order to prevent hypoventilation and hypoxemia

66
Q

What lab value would you order in a healthy 35-year-old male scheduled for outpatient hernia surgery?

A

Preoperative testing should be tailored to the individual patient and the specific surgical procedure. It is recommended that otherwise healthy asymptomatic patients undergoing operative procedures not involving
major blood loss require no preoperative testing if the patient is male and younger than 40 yrs. For females younger than 40, only a hemoglobin is indicated

67
Q

List 5 adult patients who are inappropriate candidates for ambulatory ( outpatient) surgery.

A

The following 5 adult patients are inappropriate candidates for ambulatory (outpatient) surgery: ( l} patients expected to have major blood loss or undergoing
major surgery; (2) ASA III and IV patients who require complex or extended monitoring or postoperative treatment; (3) morbidly obese patients with significant respiratory disease, including sleep apnea; (4)
patients with a need for complex pain management; and, (5) patients with significant fever, wheezing, nasal congestion, cough, or other symptoms of a recent upper respiratory infection

68
Q

List 6 other adult patients who are inappropriate candidates for ambulatory {outpatient) surgery.

A

The following 6 additional patients are not appropriate candidates for ambulatory (outpatient) surgery:
( l) patients susceptible to malignant hyperthermia;
(2) patients with uncontrolled seizure activity;
(3) patients with acute substance abuse;
(4) patients with active infection;
(5) uncooperative or unreliable patients; and
(6) patients who have no responsible adult at
home during convalescence.

SRNA4TopicsAnesthesia (47 decks)

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