Stoelting Study 8 Preoperative Eval

Front 1

11. Which patients should receive a routine preoperative electrocardiogram?

Back 1

11. A routine preoperative electrocardiogram may be recommended in men and Women older than the age of 40 or for any patient whose history indicates there may be cardiac compromise. The electrocardiogram in the operating room should be evaluated before the induction of anesthesia for every patient.

Front 2

12. Which patients should receive a routine preoperative chest radiograph?

Back 2

12. A routine preoperative chest radiograph should not be obtained unless indicated by the patient's history oqhysical examination.

Front 3

13. Which patients should receive a routine preoperative pulmonary function test?

Back 3

13. Routine preoperative pulmonary function testing should not be obtained unless indicated by the patient's history, physical examination, chest radiograph, or the surgical procedure.

Front 4

Describe what qualifies a surgical patient for each of the physical status classifications defined by the American Society of Anesthesiologists.

Back 4

15. The physical status classifications as defined by the American Society of Anesthesiologists has six classifications, followed by an "E" to denote that the surgery the patient is scheduled to undergo is emergent.

Physical status class I denotes a nonna1, healthy patient.

Physical status class IT denotes a patient with mild systemic disease that does not cause functional limitations.

Physical status class ill denotes a patient with severe systemic disease that causes the patient functional limitations.

Physical status class N denotes a patient with severe systemic disease that is a constant threat to life.

Physical status class V denotes a moribund patient not expected to survive without the operation. Physical status class VI denotes a patient declared brain dead whose organs are being harvested for donation.

Front 5

18. What is the purpose of preoxygenationl How is it achieved?

Back 5

18. The purpose of preoxygenation, or denitrogenation, is to replace the air in the patient's functional residual capacity with 100% oxygen. This allows for a greater amount of time to pass before the onset of arterial hypoxemia after the patient becomes apneic. Preoxygenation is therefore done as a safety measure. Preoxygenation can be achieved with the administration of 100% oxygen for 3 ;,:;;:~~:~~,~~ a~;~~:i~~~~~;~~~;~S~;;~~~f~l:;n:x{:;:~; volumes. Alternatively, preox:ygenation can be achieved by asking the patient to take eight maximal inspiratory and expiratory, or vital capacity, breaths of · 100% oxygen over 60 seconds. Both these methods result in similar times to arterial hypoxemia with apnea. In contrast, the patient may be asked to take four vital capacity breaths of 100% oxygen over 30 seconds, which also increases arterial oxygenation but results in shorter times to arterial hypoxemia than the oilier two method

Front 6

19. Describe a rapid sequence induction.

Back 6

19, A rapid sequence induction should be preceded with preparations such as the placement of routine monitors, confirmation of a functioning suction catheter, positioning the patient in an advantageous position to achieve intubation of the trachea by direct laryngoscopy, premedication with an antacid to neutralize the acidity of gastric contents, preoxygenation, and cricoid pressure. An induction dose of intravenous anesthetic agent, typically thiopental or propofol, followed by a dose of 1 to 2 mg/kg succinylcholine are then administered together in rapid sequence. After approximately 30 seconds, which corresponds to the onset of muscle relaxation, direct laryngoscopy should be instituted with the anesthesiologist's laryngoscope blade of choice. Only after successful intubation of the trachea has been continued by at least two methods should cricoid pressure be released. Alternatives to succinylcholine for neuromuscular blockade for a rapid sequence induction include rapacuronium at two times ED95 or rocuronium at two :o three times ED9So I

Front 7

20. When is a rapid sequence induction indicated?

Back 7

20. A rapid sequence induction is indicated when patients are at an increased risk of the aspiration of gastric contents with the induction of anesthesia and the corresponding loss of protective laryngeal reflexes. These patients should also have an airway examination that does not indicate that visualization of the glottis via direct laryngoscopy, and therefore intubation of the trachea, may be difficult. Among the patients at an increased risk of the aspiration of gastric contents are patients with neurologic compromise, intoxicated patients. patients in cardiopulmonary arrest, patients with a hiatal hernia or history of gastroesophageal reflux, patients with a history of gastroparesis, patients with an obstructed bowel, obese patients, pregnant patients, and those undergoing emergency surgery

Front 8

21. Describe an inhalation induction. I

Back 8

21. An inhalation induction is the induction of anesthesia with the patient spontaneously breathing nitrous oxide in conjunction win a volatile anesthetic by mask. Because of their relative lack of pungency, the volatile anesthetics most accepted by awake patients are halothane and sevofiurane. In some cases, the prior administration of a premedicant may be indicated.

Front 9

23. What are some objectives of maintenance anesthesia?

Back 9

23. Objectives of maintenance anesthesia are to maintain amnesia, analgesia, and skeletal muscle relaxation and to control sympathetic nervous system stimula· tion. These objectives are often achieved through combining drugs to optimize their effects.

Front 10

24. What are some advantages of nitrous oxide for general anesthesia? What are some advantage; of volatile anesthetics for general anesthesia? Why are the two often administered in combinaion?

Back 10

24. Advantages of nitrous oxide for general anesthesia include its relative lack of significant cardiovascular effects and its low blood-gas solubility. Advantages of volatile anesthetics for general anesthesia include their high potency, their ability to attenuate sympathetic nervous system responses, and their ease of administration. Nitrous oxide and volatile anesthetics are often administered in combination to decrease the concentration of the volatile anesthetic necessary comomanon to <1ecrease the concentration of the volatile anesthetic necessary that may result from the administration of volatile anesthetics alone

Front 11

25. Why might neuromuscular blocking drugs be used intraoperatively?

Back 11

25. Neuromuscular blocking drugs are used intraoperatively to ensure lack of patient movement during certain operative procedures, as in neurosurgery. With the administration of neuromuscular blocking drugs during general anesthesia there is the inherent risk of paralysis with an inadequate depth of anesthesia and resultmt patient awareness. Therefore, neuromuscular liockade must be accompanied with adequate levels of anesthesia.

Front 12

26. What are some of the advantages of injected opioids for general anesthesia? What is a disadvantage of injected opioids for general anes1hesia?

Back 12

26. Advantages of injected opioids for general anesthesia are the increased depth of anesthesia and analgesia produced with its administration in the absence of significant cardiovascular depression.\. disadvantage of injected opioids when compared with inhaled anesthetics for general anesthesia is an inability to easily titrate opioids intraoperatively.