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61 Cards in this Set
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- Back
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Preanesthetic eval objectives:
Levine 1 |
*establish dr/pt relationship
*become familiar w/ surgical illness/coexisting disease *develop mgmt strategy for periop anesthetic care *obtain informed consent for anesthetic plan |
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What should conclude preanesthetic eval.?
Levine 1 |
tell pt risks and benefits of procedure
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Overall goals of preanesthetic assessment?
Levine 1 |
reduce periop morbidity/mortality and to decrease pt anxiety
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What are your 2 sources for patient history?
Levine 1 |
*Chart review (prior to asking pt ?s)
*Asking pt themselves |
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Most accurate predictors of pt outcome?
Levine 1 |
*Age
*ASA score |
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Categories to cover when collecting pt history?
Levine 1 |
*coexisting medical illness
*meds *allergies/drug reactions *anesthetic history *family history *social history and habits |
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How do you evaluate coexisting medical illnesses?
Levine 1 |
In a systematic organ systems approach w/ an emphasis on recent changes in symptoms, signs, & treatment
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Clearance of the pt for surgery is whose responsibility?
Levine 1 |
MDA
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What data should be collected about medications?
Levine 1 |
dosages and schedule
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General rule for taking meds up to the time of surgery...
Levine 1 |
*Most can be continued up to the time of surgery
*Exclusions may include: aspirin, plavix, B blocker (consult MDA) |
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Difference b/w true allergic reaction and adverse drug reaction?
Levine 1 |
*Allergic: produces skin symptoms, facial/oral swelling, SOB, choking, wheezing, or vascular collapse
*Adverse drug reaction: memorable/unpleasant side effect |
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Most common drug allergens?
Levine 1 |
Antibiotics: sulfonamides, PCNs, cephalosporin derivatives
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Allergy (pt or family) to halothane or succ can result in what if given?
Levine 1 |
MH, halothane hepatitis, prolonged paralysis (decreased PCHe)
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What allergies must you pay attention to w/ propfol?
Levine 1 |
soybean oil and egg yolk
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Possible reaction to injection of amide type anesthetic (lido) and epi (not necessarily allergic)?
Levine 1 |
syncopal episodes, tachycardia, or palpatations
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Is a history of shellfish or seafood allergy linked to an allergy to IV iodine contrast?
Levine 1 |
No, however history of dermatitis after topical iodine may preclude use of IV iodine
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People at risk for latex allergy?
Levine 1 |
ppl with allergies to bananas, avocados, chestnuts, apricots, kiwi, and papaya or those who have frequently been exposed to HC workers and equipment
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Common narcotic side effects?
Levine 1 |
N/V & pruritus
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Adverse reactions to thiopental may result in what? Meperidine?
Levine 1 |
*T: intermittent porphyria
*M: HTN crisis when administered w/ MAOIs |
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New antiCHe treatments for alzheimers (donepezil, galantamine, and rivastigmine) may prolong the effect of what drug?
Levine 1 |
Succ
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What should you ask/look for specifically about in anesthetic history?
Levine 1 |
*response to premeds/anesthetic agents
*ease of vascular access *ease of mask ventilation *airway assessment/intubation *intra/post op complications *Narcotic requirements intra/postop *PONV *Any warnings from previous anesthetists about complications |
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What should you ask about in social history and habits?
Levine 1 |
*Smoking: no longer viewed as major risk factor
*Drugs and alcohol |
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What signs/symptoms in a smoker may warrant further pulmonary evaluation?
Levine 1 |
exercise intolerance, productive cough, hemoptysis
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Drug abuse of stimulants may lead to what symptoms?
Levine 1 |
palpitations, angine, wght loss, lowered thresholds for serious arrythmias and seizures
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What are concerns for us with a pt who is acutely intoxicated w/ ETOH?
Levine 1 |
decreased anesthetic requirements, predisposition to hypothermia and hypoglycemia
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Symptoms of ETOH withdrawal?
Levine 1 |
severe HTN, tremors, delirium, & seizures
*May increase anesthetic and analgesic requirements |
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Increased pt risk of intraop awareness associated with which drugs?
Levine 1 |
chronic opioid/benzo use
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Why is recent history of upper respiratory infection or asthma so important (especially in children)?
Levine 1 |
increases risk of bronchospasm or laryngospasm during induction & emergence
*elective procedure may be postponed |
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?s to ask about coronary artery disease to help categorize the disease?
Levine 1 |
syptoms of angina, dyspnea on exertion, paroxysmal nocturnal dyspnea, and exercise capacity
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Name ways in which diabetes can complicate anesthesia?
Levine 1 |
Autonomic nervous system dysfunction can lead to silent ischemia, gastroparesis & reflux, difficult intubation (arthritis of the temporomandibular joint)
*Find out if well-controlled |
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What should you look for on EKG if pt has history of HTN?
Levine 1 |
left ventricular hypertrophy b/c increases incidence of postop complications (stroke, MI)
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Radiation to the head/neck region increases the risk of what?
Levine 1 |
distorted airway anatomy
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Important ? to ask females when reviewing genital/urinary system? Why?
Levine 1 |
*last menses for women of childbearing age
*Premeds and anesthetic agents can decrease ureteroplacent blood flow and act as teratogens or lead to spontaneous abortion |
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Pts with obstructive sleep apnea require what 3 evaluations?
Levine 1 |
cardiovascular, pulmonary, and airway
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Focus areas for physical assessment?
Levine 1 |
airway, heart, lungs, and neurologic status
*W/ regionals--need detailed asssessment of appropriate site |
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As a minimum, the physical exam should include what?
Levine 1 |
VS (including height/weight), head/neck, precordium, lungs, abdomen, extremities, back, and neuro
*May use ideal body weight for obese pt |
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How do you measure thryomental distance?
Levine 1 |
distance b/w the tip of the chin and the thyroid notch (3 fingerbreadths is normal)
*Shorter/longer may indicate difficult intubation |
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When are hematological lab studies required?
Levine 1 |
*when there are concerns about pre/intraop blood loss, anemia, or coagulopathy
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What should you ask about when assessing platelet function?
Levine 1 |
history of easy bruising, excessive bleeding from gums/minor cuts, and family history
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When should coag studies be ordered?
Levine 1 |
bleeding diathesis, anticoag use, liver disease, or serious systemic illness
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In what types of patients are serum chemistry tests required?
Levine 1 |
chronic renal, CV, or hepatic disease, diabetics, morbidly obese pt
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At what level must hyperkalemia be treated?
Levine 1 |
> 6 mEq/ml or w/ EKG changes
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When is CXR indicated?
Levine 1 |
pts > 50 Y w/ cardiopulmonary disease undergoing high-risk surgery
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What addition test(s) are used to evaluate the severity of lung disease and response to bronchodilators in pt undergoing a lung resection?
Levine 1 |
Pulmonary Function Tests
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Medications that are typically continued on the day of surgery?
Levine 1 |
Antihypertensives (B blockers, Ca2+ channel blockers, & clonidine), anticonvulsants, antiarrhythmics, inhaled bronchodilators, anti-GERD meds, and steroids/hormonal supplements
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What two classes of antihypertensives are known for causing refractory hypotension intraop?
Levine 1 |
ACE inhibitors & angiotensin receptor blockers...so may be held on day of surgery
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Autologous blood donation in stable patients may be considered for which surgeries?
Levine 1 |
ones in which a blood transfusion is likely (ie. total joint arthroplasty or radical prostatectomy
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Reversal of aspirin and NSAID effects takes how long?
Levine 1 |
*Aspirin: 7-10 days for new platelet synthesis
*NSAIDs: 3-4 half lives |
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Risks associated w/ regional anesthesia that should be discussed w/ pt?
Levine 1 |
H/A, infection, local bleeding, nerve injury, & possible failure to provide adequate anesthesia
*Warn pt that general anesthesia may be required |
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Risk associated w/ general anesthesia that should be discussed w/ pt?
Levine 1 |
*sore throat, hoarseness, N/V, dental injury, and possible allergic reactions to drug
*when appropriate: intraop awareness, pulmonary/cardiac injury, stroke, or death, postop visual loss, postop intubation, or ICU admission |
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Risks associated w/ transfusion reactions that should be discussed?
Levine 1 |
fever, hemolytic reactions, and risk of infection (1:200,000 for Hep B & 1: 2,000,000 for HIV and Hep C)
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In what circumstance may family members (not children) be interpreters?
Levine 1 |
If the pt signs a waiver of disclosure
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What are the ASA physical status classes (1-3)?
Levine 1 |
1: healthy pt
2: pt w/ mild system disease w/out limitation of daily activities 3: pt w/ severe system disease that limits activity but is not incapacitated |
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What are the ASA physical status classes (4-6)?
Levine 1 |
4: pt w/ an incapacitating system disease that is a constant threat to life
5: a moribund pt that is not expected to survive 24 hours with or w/out the procedure 6: brain dead pt for organ donation **Add E if surgery is performed as an emergency treatment |
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ASA guidelines for NPO status preoperatively for infants, children, and adults?
Levine 1 |
*Clear liquids-2 hours
*Breast milk-4 hours *Nonhuman milk/light snack-6 hours *Fried fatty foods/meat-8 hours |
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When should HTN be treated in the periop period?
Levine 1 |
>20% above baseline, or a DBP > 115 mmHg
*If persists despite treatment, may postpone elective surgery |
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Patients at high risk for aspiration pneumonitis?
Levine 1 |
parturients, pt w/ hiatal hernias & reflux symptoms, pt w/ difficult airways, w/ ileus, obesity, poorly controlled diabetes, depressed sensoriums, and ALL trauma pt
**may treat these pt histamine antagonists (may be used immediately preoperatively), PPIs, nonparticulate antacids, or reglan |
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Cimetidine, a histamine antagonist prolongs the elimination of many drugs such as ?
Levine 1 |
theophylline, diazepam, propranolol, and lidocaine
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Cases in which doses of sedatives and analgesics should be reduced or withheld?
Levine 1 |
elderly, debilitated, acutely intoxicated pt, those w/ upper airways obstruction or trauma, central apnea, neurologic deterioration, or severe pulmonary or valvular heart disease
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A patient within how many days of an MI requires evaluation of potential for ischemia and possibly cardiac consultation?
Levine 1 |
7-30 days
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Required tests prior to operating on a hypoxic pt?
Levine 1 |
ABG and CXR
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