Pre-Op

Question 1

What does PAT stand for?

Answer 1

PreAnesthesia testing - most cost effective means of “one stop shopping”.

Question 2

What is a NORA?

Answer 2

Non-operating room area

Question 3

Where can you conduct pre-op Evals?

Answer 3

Amb Surg, NORA (MRI, Endo, Special Proc, Xray Department), On the Floor.

Can also be done on the telephone, or even in-home.

Question 4

What 6 categories (generally) will you cover in a Pre-Op eval?

Answer 4

Medical history
Surgical history
Anesthetic history
Familial anesthetic history
Drug History
Social history (drugs, herbs, alcohol, etc)

Question 5

What must be established in a pre-op airway assessment?

Answer 5

Mallampati score

Question 6

What does JAWS stand for?

Answer 6

J - Jaw thrust
A - Airways (oral/nasal)
W - Work together
S - Slow, small squeeze

Question 7

According to Article, A review of 50,000 anesthetics:
1. What is the most significant clinical predictor of impossible mask ventilation?

2. How many total impossible mask ventilation cases were observed?
3. What is the percentage overall?

Answer 7

1. Neck radiation
2. 77
3. 0.15%

Question 8

What tests are for prediction of difficult intubations?

Answer 8

Mallampati classification, Thyromental distance, interincisor distance, head & neck movement (atlantoocipictal), and mandibular mobility

Question 9

How do you calculate BMI?

Answer 9

Weight in kg/(height in meters)² = BMI

1m = 100cm

Question 10

What are the STOP and BANG questionnaires?

Answer 10

STOP-BANG for Sleep apnea
STOP:
Snoring 
Tired
Observed
blood Pressure

BANG:
BMI
Age
Neck 
Gender

Question 11

What does MET stand for?

What does it mean clinically?

Answer 11

Metabolic Equivalents (for various activities)

1 MET = poor functional capacity.
- ie self care, eating, dressing, walking around the house,walking two blocks on ground level at 2-3mph.

4 METs = Good functional capacity.
- ie housework, climbing flight of stairs without stopping, running a short distance, mod. rec activities like golf, doubles tennis, throwing a baseball.

Greater than 10 METS = Excellent functional capacity. - ie Strenuous sports like weight training, basketball, soccer,cross country skiing, swimming > 3.5 km/hr

Question 12

Current NPO guidelines

Answer 12

1. Clear liquids up to 2 hours before surgery
2. Breast milk until 4 hours before surgery
3. No infant formula, non-human milk, or light meal at least 6 hours before surgery.
4. Meds with sips of water up to 1 hour before surgery
5. No chewing gum or candy after midnight. (foreign body aspiration concern).

Question 13

ASA classes

Answer 13

Is subjective per PM.

ASA I - No disturbances
ASA II - Mild to moderate disturbance
- (DM, anemia, morbid obesity)
ASA III - Severe system disturbance
- (COPD, poorly controlled HTN, DM with vascular complications, angina pectoris, hx of MI)
ASA IV - Severe systemic disturbance that is life threatening.
- (CHF, advanced pulmonary, renal, or hepatic dysfunction.)
ASA V - Moribund pt. undergoing surgery as recusitative effort despite minimal chance of survival.
ASA E - Emergency surgery is required.
- (pt is otherwise healthy who requires a D/C for moderate but persistent hemorrhage.)
ASA VI - Dead, harvesting for transplant.