Week 4 - Labs, Chest X-Ray Interpretation and Radiation Safety Flashcards
Who must do the pre-operative assessment on the patient?
A qualified anesthesia practitioner
What has been found to be most predictive of surgical complications?
A thoughtfully executed preoperative history and physical.
What are some conditions that would benefit from early preoperative evaluations?
Poorly controlled HTN, asthma/COPD requiring medicine, morbid obesity, cervical or thoracic spine injuries
What would be suspected if a patient had vague reports of fever and convulsions last time they were under anesthesia?
Malignant hyperthermia, further investigation needs to be done to rule this out before surgery.
How can we prevent adverse drug reactions prior to surgery?
Advise patients to not take unnecessary medications preoperatively.
Most common cause of drug hypersensitivities during anesthesia?
Antibiotics and NMBA
A patient states that they are allergic to oxycodone because it makes them dizzy. What should you next step be?
Further investigate a true allergic reaction opposed to adverse reactions. A true allergic reaction is a absolute contraindication to give a drug, whereas an adverse reaction isn’t.
How long before surgery should patients be advised to not smoke?
12-18 hours
Smoking effects on the body
Hyper coagulability, increased blood viscosity, left shift on oxy-hem curve, COPD, recurrent chest infections…
Perioperative complications in children exposed to smoke
Laryngospasm, coughing on induction/emergence, breath holding, postop O2 desaturations, and hyper secretion
Anesthetic requirements are _________ in alcoholics or illicit drug users
Increased
Important to know prior to surgery (if patient will tell you)
Alcoholics have increased postoperative morbidity and mortality due to
Poor wound healing, infection, bleeding, pneumonia, and further hepatic deterioration
Most common recreational drugs
Marijuana and cocaine
Signs that indicate illicit drug use during physical exam
Evidence of drug injections, ophthalmologic changes, malnourishment, poor dental care/bruxism, and nasal perforation
How do you preform a Mallampati exam?
Ask patient to open mouth as wide as possible and maximally extrude their tongue. DO NOT phonate because this may elevate the soft palate
What does a Class IV Mallampati classification indicate?
Soft palate not visualized, tracheal intubation will be difficult
How far should patient be able to open mouth?
4 cm (2 finger widths). Less than 4 indicates difficult intubation
How would you assess a patient for mandibular mobility?
Have patient protrude the mandible in front of the central incisors. If they can do this, this indicates relative ease with maneuvering the laryngoscope.
Most common reason for anesthesia related legal claims?
Dental injuries
What should you do if you are worried about a patients risk for dental injury?
Talk to them about the risks, if they wish to proceed have them sign informed consent.
What is the ideal body weight for a 5 foot 5 inch man? woman?
Starting at 5 feet
Man = 105 + 6 lbs per per inch –> 135 lbs
Woman = 100 + 5 lbs per inch –> 125 lbs
BMI formula
Weight in kg/(height in meters)^2
What does a BMI of 32.4 indicate?
Moderate obesity
What patients are at risk for adrenal insufficiency?
Those who are/have taken 20 mg of hydrocortisone for longer than 2 weeks DURING the previous year
How does your anesthetic plan change for a patient who has taken 20 mg of hydrocortisone for a month, 6 months ago?
May be at risk for adrenal insufficiency, should be evaluated for the need of steroid coverage preoperatively.
Patients with a GCS score of less than _______ usually require tracheal intubation
8
What should be done with patients currently taking dexamethasone or methylprednisolone?
Check blood glucose levels
Hypertension is defined as blood pressure greater than
140/90 in patients aged 30-59, 150/90 in patients 60 and older
What does a MET score of 5 indicate?
Good functional capacity
What does a MET score signify?
The patients functional capacity. Set of questions to show cardiac risk
Routine testing with a 12-lead ECG _________ recommended for low risk surgeries
Isn’t
What is associated with the highest risk for a perioperative MI?
Unstable angina
Why were drug eluding stents developed?
Reduce stent thrombosis
What percentage and lower is considered reduced ejection fraction?
49%
A left ventricular ejection fraction of less than ________ is associated with a greater incidence of postoperative heart failure and death
35%
What is associated with routine beta blocker therapy on low risk patients?
Increased mortality and morbidity from hypotension, bradycardia, and stroke
Elective surgeries should be delayed for how many days in patients with bare metal stents or drug eluting stents?
Bare metal = 30 days
Drug eluting = 6 months
A patient taking an anticoagulant, without a reversal agent, should stop taking this drug ________ elimination half-lives prior to surgery
3-5, these agents should be resumed 24-48 hours postoperatively if bleeding is controlled.
Smoking patients can quit smoking _____ weeks prior to surgery, and have the complication rates of those associated with non-smokers
8
Normal phosphorus blood level
2.2 - 4.2
A safe goal of perioperative insulin therapy is to maintain glucose levels less than __________, while avoiding hypoglycemia
180 mg/dL
Blood glucose levels in patients with diabetes or medications that raise blood sugars are taken at ______ - _______ intervals in the intra-operative and postoperative period.
1 - 4 hour
What is the most common approach regarding blood sugar therapy in type 1 diabetes for brief procedures?
Give 50% of normal dose SQ of intermediate/long acting insulin, and institute 5% glucose infusion.
In what circumstances should a pregnancy test be obtained?
Whenever pregnancy is suspected. If refused, an informed consent needs to be signed regarding the risks to the fetus.
HcG serum test is standard
A modest amount of clear liquids _____ - ______ prior to surgery have been considered acceptable
2-3 hours
Purpose of the ASA classification?
Describe the physical status of the patient in a consistent manner. DOES NOT represent an estimate of anesthesia risk