3 Pre-Operative Assessment

Question 1

What is Anesthesia

Answer 1

reversible, drug induced depression of central nervous system –> loss of response and perception of all external stimuli

Question 2

Billing Terms for Anesthesia

Answer 2

General
Regional
MAC

Question 3

Components of Anesthetic State

Answer 3

unconsciousness
amnesia
analgesia
immobility
*not all applicable to regional or MAC

Question 4

General Chart Review

Answer 4

Hx: medical, surgical, social, anesthesia (MH, PONV)

ETOH, meds, labs, tests

Question 5

Should airway assessment be done with EVERY case?

Answer 5

yes

Question 6

Airway Assessment

Answer 6

mallampati

thyromental distance

Question 7

Musculoskeletal Hx

Answer 7

Chronic Diseases

Surgical Hx

Question 8

Neurological Hx

Answer 8

Hx stroke, seizure, MS, parkinsons

-document pre-existing injuries

Question 9

Cardiovascular Hx

Answer 9

• HTN
• Ischemic Heart Dx/ LV dysfunction
• Valvular Dx
• Arrhythmias
• need atleast 4 METS

Question 10

HTN

Answer 10

sys >140
dia >90
**tend to drop pressure more during induction - pre-load IVF
-maintain w/i 20% of baseline

Question 11

Angina/ MI

Answer 11

unstable places pt at risk for MI r/t stress of anesthesia

Question 12

Stents

Answer 12

plavix, coumadin or other antiplatelets?

Question 13

LVD

Answer 13

Left Ventricular Dysfunction
> Morbidity
Defined as EF < 50%

Question 14

Aortic Stenosis

Answer 14

• greatest risk for non-cardiac surgery MI

- delay elective until further testing can be done

Question 15

Beta-Blockers

Answer 15

• make sure it is received
• if not given, give in OR
• reduces risk of peri-operative ischemia

Question 16

Asthma

Answer 16

• factors, severity & frequency

- inhalers - pt brings own

Question 17

Smoking

Answer 17

increase risk of pulmonary complications

Question 18

Acute effects of nicotine

Answer 18

increase HR
increase myocardial demand
increase b/p

Question 19

OSA

Answer 19

-bring pt CPAP
-no deep extubations
-cont. pulse ox for 24 hrs post op
STOP BANG

Question 20

Small Bowel Obstruction

Answer 20

high risk for aspiration - RSI

Question 21

Mendelson Syndrome

Answer 21

• aspiration of gastric content > 25 ml

- pH < 2.5

Question 22

NPO Guidelines

Answer 22

no chewing gun
2 hrs - clears
4 hrs - breast milk
6 hrs - formula, milk
meds - 1 hr before up to 150 ml

Question 23

Diabetes

Answer 23

• hold oral diabetic medication morning of surgery (metformin hold 48 hrs prior)
• take 1/4 - 1/2 of insulin
• check BG on arrival
• total joints - always check BG in OR

Question 24

Hyperthyroid

Answer 24

sympathetic overactivity
preop goal: euthyroid state
-consider beta-blockers for increased HR (T4-T3)

Question 25

Adrenal Disorders

Answer 25

-long term steroid use may need stress dosing for procedure

Question 26

Acoholic

Answer 26

- acute intoxication: lower anesthetic requirements | - withdrawal: increased anesthetic requirements

Question 27

Cocaine Use

Answer 27

- avoid beta-blockers (decreases coronary flow) (all alpha) | - use calcium channel blockers

Question 28

Narcotic Use

Answer 28

- increase dose required to induce anesthesia - will have pain post-op - ketamine candidate - different receptors

Question 29

Atypical Pseudocholinesterase

Answer 29

-succinylcholine is unable to be metabolized.

Question 30

ASA 1

Answer 30

normal, healthy pt

Question 31

ASA 2

Answer 31

mild systemic disease | slightly limited

Question 32

ASA 3

Answer 32

- severe systemic disease, not incapacitating | - poorly controlled, chronic disease

Question 33

ASA 4

Answer 33

- severe systemic disease that is a constant threat | - life threatening

Question 34

ASA 5

Answer 34

- pt not expected to survive

Question 35

ASA 6

Answer 35

organ donor

Question 36

ASA E

Answer 36

emergent case