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27 Cards in this Set
- Front
- Back
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1. All of the following are goals of the periop eval except: a. inform the pt of risk so that informed consent can be made b. educate patient on anesthesia and events that will take place in the periop area c. complete prescriptions for post op care d. answer questions and inform the pt what meds to take the day of surgery
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Answer: c. post-op prescriptions are not part of the pre-op evaluation
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2. What are the major and minor criteria/indications for peri-op beta blockade? What are contraindications to peri-op beta blockade?
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Answer: Major indicators: ischemic heart disease, abdominal, thoracic or suprainguinal vascular surgery planned, any history of congestive heart failure, insulin-dependent DM, pre-op serum crt >2, arterial vascular disease. Minor indicators: age >70, HTN hx, total cholesterol >240, non-insulin DM, current smoker. Contraindications: hr <55, current sx of CHF or EF<30%, sick sinus syndrome or 2nd or 3rd degree AV block without pacemaker, intolerance to beta blockade, S3, rales, or wheezing on exam, poorly controlled asthma or COPD, systolic bp <100, pt undergoing SDS or one-day surgery.
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3. What is this patient’s ASA? 1. Moribund pt who is not expected to survive without the operation (i.e. ruptured AAA, PE)? 2. Pt with severe systemic disease that is a constant threat to life (i.e. CHF, unstable angina)?
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Answer: 1.)5 2.) 4 pg 163 has further examples and classifications
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4. What are risk factors for postoperative pulmonary complications?
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4. What are risk factors for postoperative pulmonary complications?
Answer: atelectasis, post-op pneumonia, acute respiratory distress syndrome, and post-op respiratory failure. Also, obesity is controversial. Pulm complications after nonthoracic surgery are more frequent than cardiac complications and are associated with greater increases in hospital length of stay. |
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5. What are the 7 preop predictors of postop respiratory failure? From highest to lowest?
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Answer: 1. Type of surgery (incr risk with incr proximity of incision to diaphragm)
2. Emergency surgery 3. Albumin <30 4. BUN >30 5. Partially or fully dependent status 6. History of COPD 7. Age (>70, 60-69, <60) pgs 165-166 |
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6. At what age is a pre-op EKG warranted for males and females?
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Answer: males: 40 females: 45
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7. Which patient populations warrant the use of routine thromboprophylaxis?
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Answer: 1. Ages >40 2. Pt undergoing major surgical procedures
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9. When administering opioids pre-operatively it is important to remember their potential side effects. Which of the following is a side effect of opioids? ? a) decreased responsiveness to CO2, b) orthostatic hypotension c) increased risk for aspiration d)N/V
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Answer: ALL OF THE ABOVE are side effects of opioid administration! Tricked you! Haha!
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10. Sphincter of oddi constriction causes biliary tract pain that may mimic chest pain after opioid administration. Giving what medication can help differentiate between the two?
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Answer: Narcan. Both are relieved by NTG, but only biliary spasm is relieved by narcan
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11. When administering an H1 antagonist such as diphenhydramine (25-50 mg) pre-op to prevent allergic reactions such as in cases using radiographic dyes, which other medication may be used as an adjuvant?
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Answer: cimetidine (H2 antagonist) to occupy peripheral receptor sites normally responsive to histamine, thus decreasing manifestations of any subsequent drug-induced releases of histamine.
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12. All of the following anticholinergics are tertiary amines able of crossing the BBB and producing sedation except: a) atropine b) scopolamine c) glycopyrrolate
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Answer: Glycopyrrolate; it is a quaternary ammonium which is unable to easily cross the bbb and thus doesn’t produce significant sedative or amnesic effects.
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13. What is central anticholinergic syndrome and what is the treatment?
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Answer: it reflects blockade of muscarinic cholinergic receptors in the central nervous system caused by scopolamine and atropine administration. Treatment: Physostigmine-1- 2 mg IV. Physostigmine is a tertiary amine, able to cross the BBB, whereas neostigmine and pyridostigmine are ineffective b/c of their quaternary ammonium structure which prevents their entrance into the CNS
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14. How do H2 antagonists work and what is an indication for their use?
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Answer: they increase gastric acid pH by decreasing Hydrogen ion concentration of secreted acid after adminstration. Indication for use: risk for aspiration.
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15. How does the MOA of a PPI differ from H2?
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Answer: PPI’s increase the gastric pH in fluid present both before and after their administration, h/e this effect may also cause an increase in gastric volume
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16. What are the general NPO guidelines for clear liquids, breast milk, infant formula, nonhuman milk, and light meals
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Answer: clr liquids-2 hrs; breast milk-4 hours; infant formula-6 hours; nonhuman milk-6 hours; light meal=6 hours; fatty meals=12 hours
**po premeds: up to 150 ml of fluid used to take PO preop meds does not introduce hazards r/t increased gastric fluid volume** |
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6 Goals of the preoperative evaluation are to
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(l) inform the patient of the risk so that an informed consent can be made,
(2) educate the patient regarding the anesthesia and events to take place in the perioperative period, (3) answer questions and reassure the patient and family, (4) notify the patient about the prohibition of ingesting food, and (5) instruct the patient about which medications to take on the day of surgery or which medications to stop taking. (6) final goal is to use the operative experience to motivate the patient to more optimal health and improved health outcomes. |
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Cause of anesthesia mishaps
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anesthesia-related mortality is very low. Investigations have suggested that equipment failure is a very minor I cause of anesthesia mishaps and that human error is the major cause of anesthesia-related problems.
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B-BLOCKERS and perioperative Prophylaxis
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b-blockers to decrease cardiac events and mortality
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The dose of b-blocker should be titrated to a target resting heart rate ofless than
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65 beats/min.
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B-Blockers should be avoided in patients with (2 types)
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asthma and used judiciously in those with chronic obstructive pulmonary disease (COPD) when spirometry demonstrates a significant bronchodilator response.
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If b-blockers are contraindicated in patients at risk for perioperative cardiac complications,
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a - agonists (clonidine, dexmedetomidine, or mivazerol) should be considered . as an alternative for cardioprotection.
A Agonists may provide these benefits by dilation of poststenotic coronary arteries and mitigation of perioperative hemodynamic disturbances. |
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:or patients who have undergone percutaneous coronary artery stent- 2 ing preoperatively for independent indications, elective i noncardiac surgery should be deferred for a minimum of __________
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6 weeks to allow endothelialization of the stents and F completion of antiplatelet therapy.
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Postoperative respiratory failure is commonly defined as
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an inability to extubate the patient's trachea 48 hours after surgery.
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3 principal patient-specific risk factors for postoperative respiratory failure
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Renal and fluid status and preoperative respiratory status
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The risk for postoperative respiratory complications is most strongly related
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to the surgical site, and the risk increases as the incision approaches the diaphragm. Upper I abdominal and thoracic surgery carries the greatest risk for postoperative pulmonary complications, ranging from s! 10% to 40%.
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the incidence of peri operative bronchospasm is creased in patients with ______. Before surgery, patients should be ______________
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asthma
free of wheezing. |
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A Pacoz higher than _____Hg has been reported to be a strong risk factor for pulmonary complications
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45 mm
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