3 - Outpatient Anesthesia

Question 1

An infant with a history of apnea and bradycardia must be asymptomatic for ________ before being considered a candidate for outpatient surgery

Answer 1

6 months

Question 2

The greatest at risk age for developing SIDS is:

Answer 2

1 month to 1 year

Question 3

Infants whose siblings died of SIDS are ________

Answer 3

5x more likely to die than the general population

Question 4

If an infant is at risk for SIDS, when can they be considered for outpatient procedures?

Answer 4

6 months to 1 year old

Question 5

Premature infants are NEVER candidates for outpatient anesthesia because (4)

Answer 5

1. Anemic
2. Lack fully developed gag reflex
3. Immature temp control
4. Immatue brainstem function, may develop resp compromise

Question 6

Why is a Hct less than 30% concerning in a newborn?

Answer 6

May increase incidence of apnea

Question 7

Postoperative apnea in infants may last as long as:

Answer 7

12 hours after surgery

Question 8

Healthy former premature infants whose postgestational age is less than ________ should be admitted for monitoring

Answer 8

50-60 weeks

Question 9

When are full term healthy infants not candidates for outpatient surgery? (3)

Answer 9

apneic episodes

FTT

feeding difficulties

Question 10

Patient age exceeding ____ is predictive of hospital admission after outpatient surgery

Answer 10

80

Question 11

When should surgeries be scheduled for patients with convulsive disorders?

Answer 11

early in the day

will need to be monitored for 4-8 hours post op

Question 12

Patients with cystic fibrosis are at an increased risk for _____ and _____

Answer 12

GERD

pulm aspiration

Question 13

Malignant hyperthermia susceptible patients have at least one of these 5 conditions:

Answer 13

1. Previous episode of MH
2. Masseter muscle rigidity with previous sx
3. 1° relative with PMH of MH
4. Mutations on chromosome 19
5. Heat induced rhabdomyolysis

Question 14

List 4 diseases caused by chromosome 19 mutation

Answer 14

central core myopathy

King-Denborough syndrome

Native American Myopathy

HypoPP

Question 15

How many vials of dantrolene should an outpatient facility have?

Answer 15

36 required

Question 16

Which patients with OSA or suspected OSA are candidates for ambulatory surgery?

Answer 16

Comorbid conditions optimized

able to use CPAP after discharge

OR

postop pain can be managed with nonopioid analgesics

Question 17

Sickle cell patients must meet what criteria to be a candidate for ambulatory anesthesia? (5)

Answer 17

1. no major organ disease 2/2 SCD
2. no crisis in past year
3. compliant with care
4. live within 15 minutes of the facility
5. close follow up care possible

Question 18

Patients with sickle cell disease are likely to develop sickle crisis if ________ occur (3)

Answer 18

acidosis

hypoxia

hypovolemia

Question 19

When should a patient with sickle cell be scheduled for surgery?

Answer 19

Early in the day

Needs preop hydration and prolonged postop monitoring

Question 20

Which morbidly obese patients are not candidates for outpatient anesthesia?

Answer 20

those with significant comorbid conditions like

angina

asthma

uncontrolled OSA

Question 21

A patient with an ASA > ____ is not a candidate for outpatient anesthesia

Answer 21

3-4

Question 22

Patient evaluation should be within ______ hours for stable and ______ hours for high risk patients.

Answer 22

30

72

Question 23

When should serum potassium levels be obtained?

For which patients?

Answer 23

within 7 days of surgery for patients receiving dig or diuretics

Question 24

Who should have a preop BG?

Answer 24

patients with diabetes controlled with meds

Question 25

How do nasal mucosa appear with an infectious URI? Allergic Rhinitis?

Answer 25

Red and inflamed ashen and boggy

Question 26

After a Lower Respiratory Infection, bronchial reactivity may persist up to

Answer 26

6-8 weeks

Question 27

List three H2 receptor antagonists

Answer 27

cimetidine famotidine ranitidine

Question 28

List three gastric PPIs

Answer 28

Omeprazole Pantoprozole

Question 29

Which has a longer duration of action: omeprazole or ranitidine?

Answer 29

Omeprazole

Question 30

Which inhalants are optimal for outpatient anesthesia?

Answer 30

desflurane and sevo rapid on rapid off

Question 31

When should IV fluids be used?

Answer 31

1. Procedure \> 30 min 2. Increased risk of PONV 3. Post op discomfort likely 4. Prolonged fasting 5. risk for bleeding 6. antibiotics required

Question 32

What are the most commons causes of hospitalization after outpatient surgery?

Answer 32

PONV and pain

Question 33

When should oral intake be required prior to discharge?

Answer 33

when it's crucial to convalescence at home diabeteic patients patients requiring post op PO meds

Question 34

When is voiding mandatory before discharge?

Answer 34

history of postop retention pelvic or urologic surgery periop catheterization

Question 35

Which is common in children: direct or indirect inguinal hernia?

Answer 35

99% are indirect more common in premature infants, especially boys

Question 36

60% of inguinal hernias occur on the ______ side

Answer 36

Right

Question 37

An elective surgery on a child with a URI is acceptable if:

Answer 37

1. no fever 2. no lower respiratory symptoms 3. No purulent discharge 4. No altered behavior (loss of apettite, disinterested in play)

Question 38

Which drug should be held preop: beta blocker or ace inhibitor?

Answer 38

Ace inhibitor. Most antihypertensives EXCEPT ACE/ARBs should be taken

Question 39

Four drugs that can help with shivering

Answer 39

demerol ketamine clonidine tramadol

Question 40

In children, when are NSAIDs most effective?

Answer 40

When combined with pre-op rectal tylenol

Question 41

For anxious patients, what anxiolytic regimen is recommended preop?

Answer 41

2-5mg versed per 70kg Taken the night before and at 6AM on the morning of the surgery (regardless of when their surgery is)

Question 42

For an anxious child in the preop holding area, what is the dose of oral versed?

Answer 42

0.25 mg/kg

Question 43

Which local anesthetic can be problematic in ambulatory care thanks to its long duration?

Answer 43

Bupivicaine

Question 44

Does bedrest reduce the likelihood of developing PDPH?

Answer 44

No In fact early ambulation may help reduce risk

Question 45

When are caudal blocks most frequently used?

Answer 45

Children with infraumbilical operations used as a supplement for anesthesia and to reduce postop pain

Question 46

What is the preferred induction agent for children?

Answer 46

Sevo Smooth induction fast on fast off

Question 47

Six ways to reduce incidence of PONV

Answer 47

1. Use regional alone if possible 2. If general, use prop instead of gas 3. Avoid nitrous 4. minimize opioids 5. Avoid paralytics 6. Consider adequate hydration

Question 48

Four predictors for PDNV

Answer 48

History of motion sickness Previous PONV Hx migraines Pain upon discharge

Question 49

What is the CTZ

Answer 49

chemotactic trigger zone in medulla

Question 50

How do versed and propofol affect PONV?

Answer 50

their antiemetic effects are longer lasting than their sedative effects