Anaesthesia - Study Points Flashcards
Evaluation of cardiac risk prior to non-cardiac surgery
- What is the incidence of an adverse postoperative cardiovascular outcome related to?
- List 2 Cardiac risk models?
- What is the Cardiac Risk Index? 6 Lee Variables?
- The incidence of an adverse cardiovascular outcome is related to the baseline risk.
- Risk models estimate the risk based on information obtained from the history, physical examination, electrocardiogram, and type of surgery. When assessing preoperative cardiac risk, we use either the revised cardiac risk index (RCRI), also referred to as the Lee index (table 1), or the American College of Surgeons’ National Surgical Quality Improvement Program risk (ACS-NSQIP) model calculator. The RCRI is simpler and has been widely used and validated over the past 15 years.
Patients with underlying cardiovascular disease, including peripheral artery disease or stroke, have an increased risk of perioperative cardiac complications compared to patients without extant atherosclerosis for which two reasons?
Outline an algorithm for assessment of the risk of a cardiovascular perioperative cardiac event.
- Steps 1-8?
- 4 Major Clinical Predictors?
- 5 Intermediate Clinical Predictors?
- 6 Minor Clinical Predictors?
Evaluation of Cardiac Risk prior to Non-cardiac surgery.
- Which symptoms should physicians enquire about? What history?
- How can cardiac functional status be determined?
At the time of the initial preoperative evaluation, the physician should inquire about symptoms such as:
1. Angina
2. Dyspnoea
3. Syncope
4. Palpitations
5. History of heart disease including ischemic, valvular, or myopathic disease
6. History of hypertension, diabetes, CKD, and cerebrovascular or PAD.
Evaluation of cardiac risk prior to non-cardiac surgery
- What features are you looking for on physical examination?
- Which patients should get an ECG as part of their preop work-up?
- What 6 things are you looking for on ECG?
The physical examination should focus on the cardiovascular system, and include blood pressure measurements, auscultation of the heart and lungs, abdominal palpation, and examination of the extremities for oedema and vascular integrity. Important findings include evidence of heart failure or a murmur suspicious for hemodynamically significant valvular heart disease.
List 9 clinical and surgery-specific factors associated with an increase in perioperative risk of a cardiovascular event?
- Which 2 other clinical predictors not included in the risk tool are also risk factors for increased risk?
Other clinical predictors — while not included in the risk factors above, the following patient characteristics have been associated with increased risk:
1. Atrial fibrillation – association between a history of prior admission for AF and postoperative complications. The risk associated with AF was higher than that associated with a diagnosis of CAD.
2. Obesity – Obese patients are at increased risk for adverse cardiovascular events at the time of non-cardiac surgery. However, obesity has not been shown to be an independent predictor.
Why do we estimate perioperative cardiovascular risk?
- List 4 risk prediction calculators?
Risk prediction calculators
1. Gupta MICA NSQIP database risk model
2. Revised cardiac risk index
3. VSGNE risk index
4. ACS-NSQIP universal surgical risk calculator
Evaluation of cardiac risk prior to non-cardiac surgery
- Outline the Gupta MICA NSQIP database risk model.
- Which 5 factors are considered?
Evaluation of cardiac risk prior to non-cardiac surgery
- Outline the VSGNE risk index for postoperative cardiovascular complications.
Evaluation of cardiac risk prior to non-cardiac surgery
- Outline the ACS-NSQIP universal surgical risk calculator for postoperative cardiovascular complications.
Evaluation of cardiac risk prior to non-cardiac surgery
- For patients determined as Higher-risk patients (whose risk of death is 1% or higher), what additional preoperative investigations might you consider? (4)
- What MET level do you not order additional tests?
Perioperative myocardial infarction after non-cardiac surgery
- List 4 cardiac complications of non-cardiac surgery and their rate of occurrence?
- Definition of MI?
- How is MI diagnosed in the setting of non-cardiac surgery?
- Cardiac complications of death, nonfatal myocardial infarction (MI), heart failure, or ventricular tachycardia occur in up to 5% of patients 45 years of age or older undergoing in-hospital noncardiac surgery.
- Of these, perioperative MI is the most common.
- Acute myocardial infarction (MI) = a clinical event that results in the death of cardiac myocytes (myocardial necrosis) and is caused by ischemia (but not other etiologies such as myocarditis or trauma)
Perioperative myocardial infarction after non-cardiac surgery
- What is Myocardial injury after noncardiac surgery (MINS)?
- Most common cause of MINS?
Perioperative myocardial infarction after non-cardiac surgery
- Outline the pathophysiology of perioperative myocardial infarction (MI)?
Perioperative myocardial infarction after non-cardiac surgery
- Discuss the incidence of perioperative MI vs. myocardial injury with noncardiac surgery (MINS)?
- Which 3 studies outline this?
- ## The incidence of MINS is higher than that for MI.
