Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

614 General Principles Of Anesthesia > Week 10 - Anesthesia Assessment > Flashcards

Week 10 - Anesthesia Assessment Flashcards

1
Q

Anesthesia Assessment includes:

A
  • Past Medical History
  • Lab results
  • Physical Status
  • Airway evaluation
  • Medication reconciliation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pre-operative Evaluation goals:

A
  • Reduce patient risk and morbidity associated with surgery and anesthesia.
  • Prepare the patient medically and psychologically.
  • Promote efficiency and cost-effectiveness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Association that requires that all patients receive a preoperative anesthetic evaluation.

A

The Joint Commission (TJC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Contains the outline for minimum requirements for preoperative evaluation.

A

The American Society of Anesthesiologists (ASA) contains the:

ASA Basic Standards for Preanesthetic Care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Conducting a preoperative evaluation is on the premise that it will: (2)`

A

modify patient care and improve outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Good pre-op evaluation can (3):

A
  • reduce cost of surgery.
  • reduce cancellation rates.
  • increase resources utilization.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Components required in a pre- op: (7)

A
  1. Review of the medical record.
  2. History and Physical (pertinent to the surgery).
  3. Appropriate diagnostic tests.
  4. Appropriate Pre-op consultations.
  5. Determine whether the patient’s condition can be improved prior to surgery.
  6. Answer all questions.
  7. Obtain informed consent.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pre-operative Evaluation challenges (6):

A
  1. Patient’s having outpatient procedures come in day of surgery.
  2. Fast turn over between cases.

Limited time to:

  1. get to know the patient
  2. create relationship.
  3. engender trust
  4. answer questions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Healthy Patient Approach

Standardization of Best Practices- enhances the process. The preop evaluation can serve as:

A

The basis for formulating best anesthetic plan tailored to the patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Forms are Rated using 3 Categories:

A

Informational Content
Ease of Use
Ease of Reading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Emergency Procedure:

Description:

Optimal timing:

Examples:

A

Description:
Life, limb, or organ-saving.

Optimal timing:
<6 hours.

Examples:
- Ruptured aortic aneurysm.
- Major trauma to thorax or abdomen.
- Acute increase in intracranial pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Urgent Procedure Classification-

Description:

Optimal timing:

Examples:

A

Description:
Conditions threaten life, limb or organ

Optimal timing:
6-24 hours.

Examples:
- Perforated bowel
- Compound fracture
- Eye injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Time Sensitive Urgency Classification

Description:

Optimal timing:

Examples:

A

Description:
Stable but requires intervention.

Optimal timing:
Days to weeks.

Examples:
- Tendon (Ex. Ruptured Achilles Tendon)
- Nerve injuries.
- Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Urgency of surgery must be weighed against the optimization of the patient.

Planned procedures: (Carotid) may require (2):

A

Neuro exam & cardiac workup/clearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Elective Procedure Classification-

Description:

Optimal timing:

Examples:

A

Description:
Procedure planned at patient or surgeon convenience.

Optimal timing:
Up to 1 year.

Examples:
All other procedures that can be planned in advance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Positive and conflicting risk factors for PONV

A

positive risk factors:
- F emale
- O pioids postop
- G eneral anesthesia (v.s. regional).
FOG
- H istory of PONV or motion sickness.
- A ge (younger, <50)
- N onsmoker
- D uration of anesthesia
- S urgery Type: cholecystectomy, laparoscopic, and gynecologic.
HANDS
- A nesthesia types: Volatile anesthetic and N2O
A
Conflicting risk factors:
- M enstrual cycle
- A SA status
- M uscle relaxant reversal
- A nesthesia provider’s experience.
MAMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Apfel PONV risk scores:

A

No risk factor = 10% chance of PONV

1 risk factor= 20% chance

2 R.F.= 40% chance

3 R.F.= 60% chance

4 R.F.= 80% chance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ephedra usage and effects/interactions:

A

For weight loss.

  • Tachycardia
  • Hypertension
  • Increased sympathomimetic effects with others (arrhythmia with digoxin and HTN with oxytocin) .
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Feverfew usage and effects/interactions:

A

for migraines.

  • PLT inhibitor
  • Increased breathing risk
  • Rebound H/A with cessation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

GBL; BD; & GHB usage and effects/interactions:

A

For body building/ weight loss. (illegal med)

  • death
  • seizures
  • unconsciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Garlic usage and effects/interactions:

A

an antioxidant and lowers cholesterol.

  • decreased PLT aggregation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ginger usage and effects/interactions:

A

anti-nausea

  • potent inhibitor of thromboxane synthetase.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ginko usage and effects/interactions:

A

Blood thinner;

Increased bleeding in pts on anti-coags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ginseng usage and effects/interactions:

A

(energy/ antioxidant);

Inhibits PLT aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Goldenseal usage and effects/interactions:

A

(laxative/diuretic)

Oxytocic= worsens edema & HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Kavakava usage and effects/interactions:

A

Anxiolytic

potentiates sedatives and hepatotoxicity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Licorice usage and effects/interactions:

A

Treatment of gastric ulcer.

HTN
Hypokalemia
Edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

St John’s Wort usage and effects/interactions:

A

(depression/anxiety);

Prolongs anesthetic effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Valerian usage and effects/interactions:

A

(anxiolytic/sedative);

potentiates sedative effects of anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Vitamin E usage and effects/interactions:

A

(slows aging);

Increases bleeding in conjunction with anti-coagulants & anti-thrombin meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Estimated Energy Requirements for Various Activities

MET 1

A
  • Daily self-care;
  • eat; dress;
  • walk indoors;
  • walk a block or 2 on ground level 2-3mph
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Estimated Energy Requirements for Various Activities

MET 4

A
  • Climb a flight of stairs or walk up a hill;
  • walk on ground level 4mph;
  • run a short distance;
  • heavy work around the house;
  • participate in moderate activities (golf, bowling, dancing, doubles tennis).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Estimated Energy Requirements for Various Activities

MET >10

A

Participate in strenuous sports like swimming; singles tennis; football; basketball or skiing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

remains one of the MOST important predictors of Peri-op risk for non-cardiac surgery; also helps define the need for further testing.

A

Exercise tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Excellent exercise tolerance (even in patients with stable angina) suggests that:

A

the myocardium can be stressed without failing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

For trauma patients, it is best to intubate in what position?

A

Neutral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Patients with severe rheumatoid arthritis or Down’s syndrome require a thorough _______ evaluation.

A

C-spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The presence of symptoms of cord compression may require ________exam.

What prompts cord compression?

A

X-ray exam;

Numbness in hand when lifting chin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

High perioperative risk of MI

A

Presence of unstable angina

40
Q

In the periop period there are __________ surges; and patient goes into a _________ state therefore exacerbates underlying issues such as angina leading to MI

A

catecholamine;

hypercoagulable

41
Q

Listen to the heart for murmur radiating to the carotids could reveal?

A

Aortic stenosis

42
Q

An abnormal heart rhythm or gallops could be?

A

Heart failure

43
Q

Presence of bruits over the carotid prior to surgery would mean?

A

Patients needs further work up for stroke risk

44
Q

M.A.C.E- Major adverse cardiac events

values:

A

Low risk procedure= <1% risk of MACE

High risk procedure= >1% risk of MACE

Advanced age= increased risk of MACE and Ischemic stroke

Hx of CV disease; DM; Cerebrovascular disease = elevated risk of MACE

45
Q

Advanced age are at increased risk of ______ and ________.

A

MACE and Ischemic stroke

46
Q

What 3 diseases support and elevated risk of MACE?

A
  • Cardiovascular disease
  • Diabetes mellitus
  • Cerebrovascular disease.
47
Q

a validated method to assign perioperative risk using clinical variables

A

The Revised Cardiac Risk Index (RCRI)

48
Q

6 independent predictors of complications in the The Revised Cardiac Risk Index (RCRI)

A
  • High-risk type of surgery
  • History of Ischemic Heart Disease
  • History of Congestive Heart Failure
  • History of Cerebrovascular Disease
  • Pre-operative treatment with Insulin
  • Pre-operative Serum Creatinine (>2mg/dL)

Cardiac complications increase with increased risk factors

49
Q

Diabetes associated with CV disease-
Diabetes accelerates ________ disease.

Diabetics have a higher incidence of:

Diabetes requiring _________ is a risk factor in the RCRI

The pre-op ECG should be evaluated for presence of ______.

A

atherosclerotic;

silent MI and myocardial ischemia.

Insulin for treatment;

Q-waves

50
Q

Hypertension is associated with increased incidence of

A

silent MI

Aggressive treatment of BP is associated with reduction in long-term MI risk

51
Q

Treat SBP > ______mmHg

Treat DBP > ______mmHg (in pts 60yrs old or >)

Elective surgery should be delayed for DBP > _______mmHg*

A

150;

90;

110

52
Q

High risk procedures:

A

Major vascular; Abdominal;
Thoracic and
Orthopedic surgeries.

53
Q

High risk procedures?

Which one is at highest risk of complication?

A

Major vascular; Abdominal;
Thoracic and
Orthopedic surgeries.

Major open vascular procedures are associated with the highest incidence of complications

54
Q

One of the most important predictors of perioperative risk for non-cardiac surgery (helps define the need for further testing and invasive monitoring).

A

Exercise Tolerance

Patients with good exercise tolerance that have stable angina suggests that the myocardium can be stressed without failing

55
Q

Patients with dyspnea associated with chest pain during minimal exertion would signal?

A

Extensive CAD and greater perioperative risk

56
Q

Early surgery after stent placement = adverse cardiac events (incidence of periop death and hemorrhage)

Delay of non-cardiac surgery for 14 days after: __________.

Delay of non-cardiac surgery for 30 days after: __________.

Delay of non-cardiac surgery for 12 months after: ______.

A

balloon angioplasty

bare metal stent placement

drug eluding stents

57
Q

Risk of re-infarction under general anesthesia after previous MI:

MI within 3 months or less = _____ incidence

MI within 3-6 months = _____ incidence

MI greater than 6 months =_____ incidence

IF re-infarction occurs, the mortality rate is _______!

A

30%;

15%

6%

50%

58
Q

T/F: Post-operative pulmonary complications occur more frequently than cardiac in patients having non-cardiac surgery.

A

True

59
Q

Post-op pulmonary complications: (5)

A
  • Atelectasis
  • Respiratory failure requiring post-op ventilation.
  • Exacerbation of COPD
  • Pulmonary edema
  • And Pneumonia
60
Q

MAJOR CAUSE OF Morbidity & Mortality post-op*

A

Post-op respiratory failure.

61
Q

Pre-operative pulmonary testing:

A

Pulmonary functions testing (PFT) and chest X-rays (CXR)-

proven to have limited benefit in predicting peri-operative respiratory failure and complications

62
Q

Decreased serum Albumin levels & Increased BUN correlates with increased risk of:

A

Peri-operative pulmonary morbidity

63
Q

Procedures are associated with the HIGHEST RISK of peri-operative pulmonary morbidity:

and

Surgeries associated with a HIGH RISK of peri-operative pulmonary morbidity:

A

Open aortic,
Thoracic
Upper abdominal

and

Cranial,
Vascular,
Neck Surgeries

These surgeries lead to decreased vital capacity; decreased FRC; and diaphragmatic dysfunction= hypoxemia and atelectasis

64
Q

Tobacco can cause (4)-

A
  • Increased carboxyhemoglobin levels.
  • Decreased ciliary function.
  • Increased sputum production.
  • Cardiovascular stimulation from Nicotine.
65
Q

________ weeks of smoking cessation is needed in order to decrease the incidence of post-operative complications* (Airways are very Reactive!!)

A

4-8

66
Q

Consider a “____ _____” if patient takes regular corticosteroids d/t adrenal insufficiency.

A

stress dose

67
Q

defined as periodic obstruction of upper airway during sleep

A

Obstructive Sleep Apnea (OSA)-

68
Q

Obstructive Sleep Apnea (OSA) leads to:

A
  • chronic sleep deprivation.
  • Chronic pulmonary hypertension.
  • Right heart failure.

These patients are susceptible to respiratory depressants! Use judiciously!

69
Q

Obstructive Sleep Apnea (OSA) characteristics:

A

NOT NU or NO NUT

  • N eck large
  • O besity
  • N asal obstruction
  • U pper airway abnormalities
  • T onsils large
70
Q

Questions to ask an OSA patient:

A

Do you snore?
Do you wake yourself up at night from snoring?
Are you tired in the daytime?
Do you have a hard time breathing?

71
Q

Diabetes Mellitus are at increased risk for

A
  • CAD, HTN, CHF, and Peri-op MI.
  • incidence of cerebral vascular, peripheral vascular and renal vascular disease.
  • Renal failure: requiring dialysis.
  • peripheral neuropathies= careful positioning
  • Gastroparesis= theoretical increased aspiration risk
  • Stiff joints d/t glycosylation of proteins (could affect airway)
72
Q

Diabetes Mellitus

Draw blood glucose on arrival, hgbA1c; Lytes; creatinine and ECG

Type 1 Diabetics= hgbA1c <_______

Type 2 Diabetics= hgbA1c <______ - or ________ or_______ .

What should you do if these are abnormal?

A

7.5%;

7%,
abnormal lytes,
ketonuria

DELAY ELECTIVE SURGERY!! optimize patient then bring them back

73
Q

Glycemic control decreases:

A
  • morbidity,
  • infection rate,
  • stroke incident
  • improves wound healing.
74
Q

Goals- Cardiac surgery= maintain sugar __________ mg/dL

A

80-100.

75
Q

Goals- non-cardiac surgery= maintain sugar <________mg/dL

A

200

76
Q

T/F: On day of surgery: hold oral hypoglycemic meds the day of surgery and hold insulin.

A

False

Hold oral hypoglycemic meds the day of surgery.
Continue insulin (consider half dose)

77
Q

Screen for s/sx of hypothyroidism-

A
  • Hypothermia
  • Hypoglycemia
  • Hypoventilation
  • Heart failure
78
Q

Screen for s/sx of hyperthyroidism -

A

THYROID STORM-

Tachycardia;
Enlarged thyroid - may create airway difficulty .
A-fib;
Muscles weakness

CHF;
Anemia
Tremor

TEAM CAT

79
Q

Hyperparathyroidism= _________ (draw ______)

A

hypercalcemia; Ca++

80
Q

Hyperparathyroidism s/s: (7)

A

B AWHILE

  • B one pain
  • A pathy
  • W eakness
  • H eadache
  • I nsomnia
  • Lethargy
  • Epigastric pain
81
Q

Adrenal cortical suppression:
Be suspicious of those on long term steroid use Cushing’s- S//S:

A

moon face;
skin striation;
truncal obesity &
HTN

82
Q

Adrenal cortical suppression:

Make sure that they get a stress dose if steroids were taken for _____ month(s) or greater within the last ______ months (if more than a minor procedure).

A

one;

6-12

83
Q

Stress dose

A

Max dosing= 100mg hydrocortisone IVP before surgery, then q8h x 1 day, then 50mgIVP— highly debated*

84
Q

What things to keep in mind with renal disease pt in pre-op? (3)

A

Assess electrolytes

Make patient euvolemic prior to induction (likely dry if hemodialysis recently)

Be mindful of meds metabolized by kidneys

85
Q

What things to keep in mind with liver disease pt in pre-op? (3)

A
  • Coagulopathy (know levels before regional).
  • Decreased plasma proteins- affects drug binding.
  • Consider labs if increased ETOH history
86
Q

When to get a CBC:

A

extremes of age;
liver or kidney disease; anticoagulant use; bleeding;
hematologic disorders; malignancy;
type & invasiveness of surgery

87
Q

When to get COAGS:

A

Bleeding disorder;
Liver disease or
Anticoagulant use;
Chemotherapy
Kidney disease;

BLACK

88
Q

When to get Serum Chemistry:

A

(Glucose, Electrolytes, renal and liver function).

  • Liver or kidney disease;
  • DM;
  • CNS disease;
  • Endocrine disorder;
  • Elderly; Malnutrition;
  • Type & invasiveness of surgery.
89
Q

When to get to CXR:

A
  • pulmonary disease or clinical findings (r/o pneumonia or pulmonary edema);
  • unstable cardiovascular disease;
  • type & invasiveness of surgery
90
Q

When to get to ECG:

A
  • CV disease or clinical findings;
  • pulmonary disease;
  • type & invasiveness of surgery
91
Q

When to get pregnancy test:

A

possible pregnancy (child bearing years)

92
Q

Aspiration risks (10):

A

ROO INHALED

  1. Reflux
  2. Obesity
  3. Opiates
  4. Inadequate (light) Anesthesia
  5. Neuro Deficits
  6. Hiatal Hernia
  7. Abdominal pathology
  8. Lithotomy
  9. Emergency Surgery
  10. Difficult Intubation
93
Q

Fasting Times-

Clear liquids=
Breast milk=
Infant formula=
Non-human milk=
Light meal=

A

2 hour minimum

4 hour minimum

6 hour minimum

6 hour minimum

6 hour minimum

94
Q

Aspiration Risk:
Medications and what do they do?

A

Bicitra: Increases gastric pH in 100% of the cases it is used – Highly effective antacid

Famotidine: Increases gastric pH

Reglan: Increases gastric emptying

95
Q

Reglan is good for which patients?

A

obese;
pregnant;
diabetics;
trauma & emergency surgery.

614 General Principles Of Anesthesia (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions