Comorbidities

Question 1

Obesity Classes?

Answer 1

Normal 18.5-25
Overweight 25-30
Obese class 1 30-35
Obese Class 2 35-40
Obese Class 3 (Morbid or Severe) 40-50
Super Obese >50

Question 2

What is Obesity Hypoventilation Syndrome?

Answer 2

Combination of obesity, Chronic Daytime Hypercapnia (PaCO2 > 45 mmHg), and sleep disordered breathing.

Question 3

Preop changes for Obese patients?

Answer 3

Assess for CAD/CHF/OSA (STOPBANG)/GERD/NAFLD/Restrictive Lung Disease?
Assess for recent weight change.
Forearm NIBP had better measurement performance than upper arm or lower leg readings.
375-400 lbs Patient Requires bariatric ambulance.
Have them bring their own CPAP

Question 4

PreOp questions for COPD?

Preop Eval for COPD

Answer 4

• Cough? Sputum production? frequency of infections/exacerbations? exercise tolerance? and past therapies?
  
  • Emphysema? Bronchitis? Asthma?
  • Evidence of lower extremity swelling (RV involvement)?
  • Expiratory Wheeze? Decreased Breath Sounds?
  • Interventions:
    ○ Encourage smoking cessation
    ○ Treat Evidence of airflow obstruction
    Infection with Abx

Question 5

Symptoms of Hypothyroidism?

Answer 5

fatigue; constipation; weight gain; cold intolerance; a deep voice; coarse hair; and dry, pale, cool skin

Question 6

Stress Test vs Dobutamine Stress test?

Answer 6

A stress test induces ischemia with exercise and detects ischemia by ECG changes. A dobutamine echo induces ischemia with dobutamine (a B1 inotrope) and detects ischemia by regional wall motion abnormalities

Question 7

Other name and mechanism of action for Afrin

Answer 7

adrenergic α1- and α2-agonist and a direct-acting sympathomimetic drug

Question 8

Nasal intubation what to use for nasal passages?

Answer 8

Afrin, Phenylephrine, Lidocaine Gel 2% or a spray. May use cocaine but controlled substance and may get HTN with systemic absorption

Question 9

How do diagnose Carbon Monoxide poisoning?

Answer 9

Co-Oximetry and elevated carboxyhenoglobin

Question 10

Why can burn patients get hyperkalemia from succinilcholine?

Answer 10

Proliferation of fetal and A7 extra junctional acetylcholine receptors

Question 11

What to do for patient with hepatitis perioperatively?

Answer 11

Avoid hypovolemia, hypoxia, and any hepatotoxin.

Question 12

Transfusion goals for Sickle cell patient?

Answer 12

○ Low risk procedures hardly ever need transfusion
○ Moderate to High risk needs HCt total to be 30%
○ < 30% HgbS may be desireable for high risk
○ < 5% HgbS for cardiac surgery with bypass
Exchange Transfusion with Hydroxyurea

Question 13

Issues with Hypothermia?

Answer 13

It may predispose to infection, coagulopathy, myocardial ischemia, delayed drug clearance, delayed discharge, and sickling. Deleterious physiologic changes that may occur with hypothermia, especially in the sickle cell patient, include increased viscosity, a rightward shift of the O2-Hgb dissociation curve, vasoconstriction, and shivering

Question 14

Definition of pulmonary hypertension?

Answer 14

PA systolic pressure > 35mmHg
Mean PA pressure > 25mmHg at rest
Mean PA pressure > 30mmHg during exercise

Question 15

How to avoid exacerbation of pulmonary HTN while under anesthesia?

Answer 15

Avoid hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia.