Surgery Cf Ch 38 Preoperative Risk Assessment And Optimization

Front 1

1. Revise Cardiac Risk Index (RCRI)?

Back 1

a. A six-point scoring system that has been shown to help stratify the risk for perioperative cardiac morbidity in elective surgery patients:
1. Ischemic heart disease
2. Congestive heart failure
3. Cerebrovascular disease
4. High-risk surgery (abdominal, thoracic, vascular, major orthopedic procedures
5. Insulin-dependent diabetes
6. Serum creatinine >2 mg/dL.

Front 2

2. What drugs appear significantly reduce cardiac morbidity in moderate and high risk patients with RCRI >2?

Back 2

a. Perioperative beta blockers.

Front 3

3. Metabolic (MET) demand?

Back 3

a. An arbitrary measure of the aerobic demands of specific activities
b. Perioperative cardiac and long-term risks are increased for patients unable to meet a 4-MET demand during most of their daily living. (Activities of daily living is dressing and cooking require from 1 to 4 MET; planning a flight of stairs, walking 6 mph?; And scrubbing the floor require 4-10 MET).

Front 4

4. Resting left ventricular function?

Back 4

a. Generally assessed by Echo.
b. A patient with a left ventricular ejection fraction (LVEF) less than 35% has a significantly increased risk perioperative cardiac complications.
c. However, a LVEF >35% does not reliably rule out the development of cardiac complications.

Front 5

5. Dobutamine stress echocardiography?

Back 5

a. Provocative testing under a controlled setting involves the administration of IV dobutamine to evaluate cardiac status of patients who are unable to undergo an exercise stress test.
b. Test results are positive when patient develops symptoms and/or wall motion abnormalities as revealed by echocardiography
c. Vascular surgery patients with positive test results have a 7 to 23% risk for perioperative and MI (low false-negative rate/high sensitivity).

Front 6

6. What must be done when preparing a patient with significant medical conditions for elective surgery?

Back 6

a. The patient's comorbidity problems must be clearly defined and addressed during the perioperative period.
b. An assessment of comorbidity has been found to be particularly important for patients undergoing vascular surgery procedures.
c. The assessment of cardiac risk consists of 8 steps.
d. Several major, intermediate, and minor clinical predictors can be used to determine patient risks.
e. Clinical history, the patient's current symptoms, and the level of physical activity are important in determining a patient's risk!!!
f. Notably, in vascular surgery patients, coronary artery disease may be clinically silent because of limited activity and/or coexisting diabetes.

Front 7

7. Other major component in risk assessment?

Back 7

a. Stratification of cardiac risk associated with the proposed operative procedure.
b. The combination of patient risk and procedural risk is used to determine if additional testing, pharmacologic intervention, coronary intervention, or perioperative monitoring is indicated.

Front 8

8. Major clinical predictors of cardiac risk?

Back 8

1. Unstable coronary syndrome
2. Decompensated CHF
3. Significant arrhythmias
4. Severe valvular disease

Front 9

9. Moderate clinical predictors of cardiac risk?

Back 9

1. Mild angina pectoris
2. Prior myocardial infarction
3. Compensation CHF or prior CHF
4. Diabetes

Front 10

10. Minor clinical predictors of cardiac risk?

Back 10

1. Advanced age
2. Abnormal ECG
3. Rhythm other than sinus
4. Low functional capacity
5. History of stroke
6. Uncontrolled systemic hypertension

Front 11

11. What is sufficient for evaluation of the patient underwent surgical revascularization coronary vessels 4 years ago and has had no recurrence of symptoms?

Back 11

a. History
b. Physical exam
c. Lab tests
d. ECG

Front 12

12. How risky are most body surface operations (eg, hernia repair, breast surgery)

Back 12

a. The can be safely completed with minimal idiolog expressed patients.

Front 13

13. Risk versus benefit of perioperative beta blockade?

Back 13

a. Has been shown to reduce cardiac morbidity in high-risk patients
b. However, this intervention has also been shown to produce complications including bradycardia, hypotension, and cardiac arrests.
c. Therefore, this therapy should be applied towards moderate and high risk patients

Front 14

14. Note: perioperative cardiac risk is low when patients have completed surgical coronary revascularization within 5 years or have undergone coronary angioplasty from 6 months to 5 years prior and had no symptoms of ischaemia

Back 14

14. Note: perioperative cardiac risk is low when patients have completed surgical coronary revascularization within 5 years or have undergone coronary angioplasty from 6 months to 5 years prior and had no symptoms of ischaemia

Front 15

15. Note: the benefits of obtaining a thorough history and physical and adjusting medications directly planned elective procedures should never be overlooked.

Back 15

15. Note: the benefits of obtaining a thorough history and physical and adjusting medications directly planned elective procedures should never be overlooked.