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Special Pop Exam 1 > Week 5: Part 1 > Flashcards

Week 5: Part 1 Flashcards

1
Q

70% of surgeries in the US occur at ___________ facilities

A

to include hospital outpatient centers connected to hospitals or free standing and independent outpatient surgery centers

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2
Q

benefits of ambulatory/outpatient surgery centers (5)

A
  • Cost effective
  • Easier scheduling
  • Profitable (yes or they wouldn’t be working here)
  • Less likely to be cancelled? (riskier cases/profit driven)
  • Most patients can be easily managed at home, low rates of postoperative complications
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3
Q

5 changes for outpatient anesthesia

A
  • Movement of more procedures into ambulatory settings (Total knee)
  • Increased use of regional under ultrasound guidance
  • Use of multi-modal preemptive analgesia
  • Development of outpatient anesthesia as a sub-specialty
  • Increased emphasis on the regulatory environment (FL - ACHA)
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4
Q

goals of ambulatory surgery (7)

A
  • Safety
  • Minimal PONV
  • Excellent surgical conditions
  • Excellent post op analgesia
  • High patient satisfaction
  • Efficient, rapid recovery
  • Value, Cost
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5
Q

3 risk assessment tools

A

ASA PS

POSSUM

Revised Cardiac Risk Index

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6
Q

scores we use on PreOp Evals

A

ASA PS

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7
Q

On-line Risk Calculation Tool (accounts for all factors & Labs)

A

POSSUM

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8
Q

many Epic PreOp Eval systems have this

A

RCRI

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9
Q

what is risk stratification used for?

A

Postoperative outcome measures to assess recovery after ambulatory surgery

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10
Q

patient selection for outpatient surgery

A
  • ASA I-III, in good health with controlled and medically stable diseases
  • Occasional ASA IV patients
  • Weigh the Benefits and Risks
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11
Q

which pediatric patients may undergo outpatient surgery

A
  • Non-anemic, Full term infants greater than 46 weeks post-conceptual age (PCA)
  • Prenatal history on assessment should include prematurity, apnea and bradycardic spells (if present not to be done in outpatient (non-hospital) setting
    ASA Pediatric Guidelines:
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12
Q

Age at which premature and full-term infants can safely undergo surgery and be discharged…

A

remains controversial

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13
Q

for ex-preemies, apnea may not occur until ____________ hours

A

12 hours

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14
Q

Any infant with apnea in PACU regardless of age should be …

A

admitted to the hospitalf

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15
Q

for patients a with a family hx of SID, infants who lost siblings to SIDS should not be considered for outpatient surgery until ____________

A

6 months to 1 year

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16
Q

anemia of a Hct less than ____________ may increase the incidence of apnea

A

30%

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17
Q

Independent risk factors for adverse respiratory events:

A
  • ET tube
  • history of prematurity
  • Hx of reactive airway
  • parental smoking
  • surgery in the airway
  • nasal congestion
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18
Q

Young children generally are frequently between ____________

A

infections

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19
Q

Airway may remain hyperactive for ____________ after surgery

A

4-6 weeks

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20
Q

generally safe to proceed with general anesthesia for a kid who has an URI if…

A
  • No fever >38.5 C
  • No purulent discharge
  • No lower respiratory tract signs
  • No altered behavior
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21
Q

what are clear liquids

A

black coffee, clear tea, water

22
Q

how long to be NPO with clear liquid diets

A

2 hours

23
Q

how long to be NPO for breast milk

A

4 hours

24
Q

infant formula time to be NPO

A

6 hours

25
Q

light meal is considered

A

toast and clear liquids

26
Q

heavy meals include

A

fried or fatty foods

27
Q

how long should patient be NPO for a heavy meal

A

8 hours

28
Q

advanced age care should be based on

A

physiologic rather than chronologic age

29
Q

T/F ASA III and IV can be done in outpatient sites as long as their systemic diseases are medically stable

A

true

30
Q

for patients with convulsive disorders that are controlled, how should outpatient surgery be scheduled?

A
  • schedule early in the day (observed up to 8 hours post - surgery)
  • Continue to take medications
31
Q

should candidates with uncontrolled convulsive disorders be candidates for outpatient surgery?

A

NO

32
Q

are patients with cystic fibrosis candidates for outpatient surgery?

A

extent of disease process should be determined

33
Q

for a patient with a PMH of malignant hyperthermia, how should outpatient surgery be scheduled?

A
  • Schedule patient early in the day
  • Any increase in temp, rigidity should be observed for
34
Q

what are the minimum malignant hyperthermia pharmacologic agents that should be in an out patient surgery center

A
  • (36) vials of Dantrolene available (MH cart) total dose of 720 mg
  • (3) 250 mg vials of Ryanodex (Expensive) for total dose of 750 mg
35
Q

what do the letters in STOP BANG stand for?

A
  • Snoring (loud enough to be heard through closed doors/elbow sign)
  • Tired (sleepy, tired or fatigued during the day)
  • Observed Apnea (anyone see you stop breathing or gasping during sleep)
  • Pressure (Have/or have been treated for high blood pressure)
  • Body Mass index more than 35 kg/m2
  • Age older than 50
  • Neck size large (Greater than 40 cm)
  • Gender: male
36
Q

low risk of OSA STOP BANG score

A

0-2

37
Q

intermediate risk STOP BANG score

A

3-4

38
Q

high risk STOP BANG score

A

5-8

39
Q

what BMI is not a good outpatient candidate

A

BMI>/= 50 kg/m2 may not be a good outpatient consideration

40
Q

if patient uses CPAP what should they do the day of surgery

A

bring it!

41
Q

what pharmacologic agents should be minimized for obese patients

A

versed and opioids

42
Q

what are good anesthesia methods in obese patients

A

regional and local infiltration

43
Q

discharge criteria for obese patients

A
  • Return to room air oxygen saturation to baseline
  • No hypoxic episodes or periods of airway obstruction when left alone
  • Monitoring for a minimum of 3 hours more than non-OSA (ASA guideline recommendation)
  • Monitoring for 7 hours following episode of airway obstruction or hypoxemia on room air/un-stimulated
44
Q

May be a “Definite NO” for Outpatient Surgery

A
  • Unstable ASA III or IV
  • Active alcohol/substance abuse
  • No caregiver
  • Poorly managed OSA, Morbid obesity with comorbidities
  • Ex-premie less than 60 weeks post-conceptual age under ET anesthesia
  • Active infection/sepsis
    Potential for uncontrolled pain relief
45
Q

ERAS Protocols

A
46
Q

reasons to postpone surgery

A
  • Uncontrolled disease or lack of drug compliance (HTN, diabetic)
  • Not NPO
  • Suspicion of Pregnancy
  • Acute URI (most common reason surgery cancelled in children)
  • Case running late into day?
47
Q

premedication considerations

A
  • Minimal effective dose and patient specific
  • Not every patient needs preop meds
  • Outpatient preparation is not much different than in the hospital
  • Pain Control/Opioids/NSAIDS/Tylenol/Gabapentin/Celebrex
  • Nausea/vomiting
48
Q

fast- track general anesthesia techniques (4)

A
  • Rapid return to consciousness and protective reflexes
  • Minimal residual effects
  • Avoid deep anesthesia?
  • Early postoperative intake and ambulation
49
Q

SAB and Epidural concerns

A

Worry about dural puncture issues, prolonged block, urinary retention, residual sympathetic block (low dose)

50
Q

advantages of regional anesthesia in ambulatory surgery

A

great way to control intraop and postop pain, decrease anesthetic medications, decrease N/V and risk of aspiration, quicker discharge

51
Q
A

Special Pop Exam 1 (16 decks)

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