4. Pre-op: Neuro, Cancer, Obesidade, Laboratorio

Question 1

O que deve ser avaliado no exame neurológico basico do pre-op em pacientes com doenca neurologica? (6)

Answer 1

• Status mental
• Fala
• Nervos cranianos
• Marcha
• Funcao motora
• Funcao sensitiva

This baseline determination also allows for comparison of any new postoperative deficits.

Question 2

The risks of postoperative cardiac complications and recurrent stroke are particularly elevated when elective noncardiac surgery is performed within __1___ after a prior stroke.

Based on these emerging data, a 2021 scientific statement from the AHA and American Stroke Association suggested delaying elective noncardiac surgery for at least __2___ after an acute stroke.

Answer 2

1. 6 months
2. 6 months

Question 3

Paciente com AVE/AIT previo, o que investigar a respeito disso no pre-op?

Answer 3

• Temp
• Apresentacao
• Etiologia (ateroesclerose, cardio-embolia, etc)
• Tratamento

Question 4

Fatores de risco para Sopro Carotideo (2)

Answer 4

• Doenca cardiovascular (HAS, tabagismo, DM, dislipidemia, doenca cardiacă isquemica, doenca arterial periferica)
• Radiacao previa de cabeza e pescoco

Question 5

Perguntas a serem feitas em pacientes com Sopro Carotideo Assintomatico

Answer 5

• Amaurose fugaz
• Disfagia
• Disartria
• outros sintomas de insuficiencia cerebrovascular

Question 6

O que é a sindrome da hipoventilacao da Obesidade?

Answer 6

Reducao do drive ventilatorio central

• Hipoxemia cronica (PaO₂ < 65mmHg), acordado, sem diagnostico de DPOC ou doenca pulmonar primaria

Question 7

Fatores de risco para alergia a latex (3)

Answer 7

• Multiplas cirurgias
• Exposicao ocupacional a latex (profissionais de saude, manipulação de alimentos)
• Historia de atopia

Question 8

Em que tipo de reacao adversa a penicilina é importante nao usar Cefazolina?

Answer 8

• Anafilaxia
• reacao mediada por celula-T (NET, SJS)

Question 9

For patients taking naltrexone for OUD or alcohol use disorder, consideration should be given to discontinuing it ___1___ preoperatively

Answer 9

1. two to three days

Question 10

Patients who are taking disulfiram because of a history of alcohol use disorder may have an altered response to ___1___ drugs; some authors therefore suggest that disulfiram be discontinued ___2___ before the surgical procedure

Answer 10

1. sympathomimetic
2. 10 days

Question 11

In general, testing does not have to be repeated during the preoperative evaluation of healthy patients (i.e., ASA-­ PS class 1 or 2) if similar testing had already been performed within the ___1___ preceding surgery, and there had been no major interval change in the patient’s medical status (e.g., recent chemotherapy)

Answer 11

1. two months

Question 12

Quais pacientes devem ter Coagulograma solicitado? (5)

Answer 12

• ASA 3-4
• cirurgias de porte intermediario, grande ou complexas
• Anticoagulantes
• Doenca hepatica cronica
• Disturbios de coagulacao

Question 13

A reasonable approach (to screen for Sickle Cell Disease) is to focus preoperative screening in previously untested patients who have at-­ risk ethnic backgrounds and clinical indicators. The indicators include: (2)

Answer 13

• Patient related
• Surgery related