Week 1 Flashcards
The purpose of Pre-op
provide the patient with an estimate of anesthetic risk
obtain informed consent
anesthetic plan
identify patients that will have that will need additional testing or patients that are so poor condition it will cause death
pre-op items
H&P-to include- planned procedure, allergies, medications(current and past), substance abuse, responses to previous anesthesia. illness (current and past) (METs). (ASA standards). last oral intake.
consults
specific diagnostic testing
Metabolic equivalent of 4 or more
predicts a low risk of preoperative complications
ASA 1
a normal health patient. health, non smoking no or minimal alcohol use.
ASA II
a patient with mild systemic disease
mild diseases only without substantive functional limitation. Eg smoker, social drinker, pregnancy obesity BMI 31-39. well controlled dm/htn mild lung disease
ASA III
a patient with severe systemic disease
substantive functional limitations; one or more moderate to severe diseases. poorly controlled dm. htn cold morbid obesity active hepatitis alcohol dependence or abuse. BMI >=40 implanted pacemaker moderate reduction of ejection fraction. ESRD undergoing scheduled dialysis. premature infant PCA <60 weeks history >3 months of MI, CVA, TIA, or CAD/stents
ASA IV
a patient with severe systemic disease that is a constant threat to life.
< 3 months MI, CVA, TIA, or CAD/Stents, ongoing cardiac ischemia or severe valve dysfunction. severe reduction of ejection fraction, sepsis, dic, ards, or esrd not undergoing regularly scheduled dialysis.
ASA V
a moribund patient who is not expected to survive without a operative
examples include but are not limited to reputed abdominal thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowl in the face of significant cardiac pathology or multiple organ/system dysfunction.
ASA VI
a declared brain dead patient whose organ are being removed for donor purposes
ASA E
Emergency surgery - delay of the patient would lead to a significant increase in the threat to life or body part.
1 MET=
3.5mlO2/min/kg of body weight.
Difficult Mask Ventilation
age greater than 55 BMI Greater than 26 beard lack of teeth OSA previous head/neck/radiation/surgery or trauma
Findings for difficult direct laryngoscopy
osa
hx difficult intubation/aspiration pna after intubation/ dental or oral trauma following intubation.
previous head/neck/radiation/surgery or trauma
obesity cervical spinal disease or surgery
congenital disease: downs syndrome teacher collins & pierre robin
inflammatory arthritic disease. rheumatoid arthritis, enclosing spondylitis, scleroderma.
Findings for difficult airway examination component
length of upper incisors relationships of maxillary and mandibular incisors during normal jaw closure. relationship of maxillary and mandibular incisors during voluntary protrusion of mandible inter incisor distance visibility of uvula compliance of the mandibular/oral space thyromental distance length of neck thickness of neck range of motion of the head and neck
micrognathia
a short distance between the chin and the hyoid bone. prominent upper incisors, a large tongue, limited range of motion of the temporomandibular joint or cervical spine, or a short or thick neck suggest that difficulty may be encountered in direct laryngoscopy for tracheal intubation
mallampati class1, 2, 3, 4
class 1 = soft palette, uvula, fauces, pillars
class 2= soft palette, uvula, fauces
class 3 = soft palette base of uvula
class 4= soft palette not visible
STOP-BANG
snoring tiredness observed- stop breathing pressure Bmi greater than 35 Age>50 N-neck Gender male
when should anti platelets be held after Bare metal stent
1 month
albumin
anasarca, liver disease, malnutrition, malabsorption
b-hcg
suspected pregnancy
cbc
alcohol abuse, anemia, dyspnea, hepatic or renal disease
