Anesthesia Consultation I Flashcards Preview

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Flashcards in Anesthesia Consultation I Deck (66):
1

What is the purpose of the preoperative consultation? 

To reduce the patient’s surgical and anesthetic perioperative morbidity or mortality, and to return the patient to desirable level functioning as quickly as possible.

2

“Perioperative risk” is multifactorial and a function of: (3)

  • the preoperative medical condition of the patient
  • the invasiveness of the surgical procedure
  • the type of anesthetic administered

3

Surgical procedures and administration of anesthesia are associated with a complex stress response that is proportional to: (4)

 the magnitude of injury
total operating time
amount of intraoperative blood loss
degree of postoperative pain

4

What is the key factor in improving outcome and lowering the length of hospital stay as well as the total costs of patients care?

Decreasing the stress response to surgery and trauma 

5

What are the goals of preoperative evaluation? (7)

  • Documentation condition(s) for which surgery is needed.
  • Assessment overall health status.
  • Uncovering of hidden conditions.
  • Perioperative risk determination.
  • Optimization of pt health status.
  • Development perioperative care plan.
  • Education of the patient about surgery/recovery.
  • Reduction of costs/shortening hospital stay.

6

What is the most important component of the preoperative evaluation?

patient history

7

What should the patient history include? (8)

  • a past and current medical history
  • a surgical history
  • a family history
  • a social history (use of tobacco, alcohol and illegal drugs)
  • a history of allergies
  • current and recent drug therapy
  • unusual reactions or responses to drugs and any problems or complications associated with previous anesthetics.
  • family history of adverse reactions associated with anesthesia should also be obtained.

8

A focused pre-anesthesia physical examination includes: (2)

  • an assessment of the airway
  • lungs and heart, with documentation of vital signs

9

When is a complete blood count needed? (4)

  • major surgery
  • chronic cardiovascular, pulmonary, renal, or hepatic disease, or malignancy
  • known or suspected anemia, hemorrhage, or myelosuppression
  • less than 1 y/o

10

When is an PTT/INR indicated? (3)

anticoagulant therapy

bleeding diathesis (hemorrhage)

liver disease

11

When are electrolytes and creatinine labs indicated? (5)

HTN

renal disease

diabetes

pituitary or adrenal disease

digoxin or diuretic therapy

12

An EKG is indicated prior to surgery for these patients: 

  • heart disease, HTN, diabetes
  • other risk factors for cardiac disease
  • subarachnoid or intracranial hemorrhage, CVA, head trauma

13

When is a CXR indicated preoperatively?

cardiac or pulmonary disease

malignancy

14

When should MAO be withdrawn prior to surgery?

Why?

2-3 weeks

risk of interactions with anesthetics

15

When should oral contraceptives be discontinued before elective surgery? 

Why?

6 weeks

increased risk of venous thrombosis

16

When should patients discontinue their herbal supplements?

2 weeks prior

17

When should aspirin be discontinued prior to surgery?

7-10 days

18

When should thienopyridines (such as clopidogrel) be discontinued prior to surgery?

2 weeks before 

19

When should oral anticoagulants be discontinued prior to surgery?

What should INR level be?

4-5 days

1.5

20

What are major clinical predictors of increased risk for perioperative cardiac complications?

recent MI

unstable or severe angina

decompensated CHF

significant arrhythmias

severe valvular disease

 

21

What are intermediate clinical predictors of increased risk for perioperative cardiac complications?

mild angina

prior MI history

compensated CHF 

diabetes

renal insufficiency

22

What are minor clinical predictors of increased risk for perioperative cardiac complications?

advanced age

abnormal ECG

rhythm other than sinus

poor functional capacity

history of stroke

uncontrolled HTN

23

What are high risk predictors for perioperative cardiac complications?

emergency surgery

aortic and major vascular surgery

prolonged surgical procedures with large fluid shifts or blood loss

unstable hemodynamic situations

24

What are intermediate risk procedures for perioperative cardiac complications?

abdominal or thoracic surgery

neurosurgery

ENT procedures

minor vascular surgery

orthopedic surgery

prostatectomy

25

What are low risk procedures for perioperative cardiac complications?

breast surgery

superficial surgery

eye surgery

endoscopic procedures

plastic and reconstructive surgery

ambulatory surgery

26

What functional capacity, METS:

standard light home activities
walk around the house
walk 1-2 blocks on level ground at 3-5 km/hr

 

1-4 mets

27

What functional capacity, METS:

climb a flight of stairs 
walk up a hill
run a short distance
moderate activities like golf, dancing, mounting walking

5-9 METS

28

What functional capacity, METS:

strenuous sports (swimming, tennis, bicycle)
heavy professional work

>= 10 METs

29

What does METs stand for?

metabolic equivalents of oxygen consumption

30

What are postoperative pulmonary complications? (7)

Pneumonia
Atelectasis
Bronchitis
Bronchospasm
Hypoxemia
Respiratory failure with prolonged mechanical ventilation
Exacerbation of underlying chronic lung disease 

31

What ASA status is a patient with mild systemic disease?

ASA 2

32

What ASA status is a patient with severe systemic disease?

3

33

What ASA status is a patient with severe systemic disease that is a constant threat to life?

ASA 4

34

What ASA status is a moribund patient who is not expected to survive w/out the operation?

ASA 5

35

What ASA status is an organ donor?

ASA 6

36

What are risk factors for postoperative pulmonary complications? 

procedure-related risk factors

length of surgery

emergency surgery

underlying chronic pulmonary disease

smoking

age >60

obesity

presence of sleep apnea

poor exercise tolerance

37

What patient should be carefully assessed preoperatively for symptoms and signs of peripheral vascular, cerebrovascular and coronary disease?

diabetics

38

What do diabetics have a higher incidence of death after ____ than non-diabetic.

MI

39

What should be administered prior to surgery for a diabetic prior to surgery to limit perioperative ischemia?

beta-blockers

40

When should you treat blood glucose perioperatively?

> 180 is a good rule of thumb

41

What are perioperative hyperglycemia complications?

dehydration

impaired wound healing

inhibition of WBC 

42

For dental extractions, arthrocentesis, biopsies, ophthalmic operations and diagnostic endoscopy patients need to alter their regimen. True or false?

false

do not need to

43

What drugs should be considered for the anticoagulated patient? 

IV heparin

LMWH (low molecular weight heparin)

44

Invasive surgery is generally safe (from major hemorrhagic complication) when the INR ~___.

1.5

45

It takes approximately __ days for the INR to reach 1.5 once oral anticoagulant is stopped preoperatively.

4

46

It takes approximately __ days for the INR to reach 2.0 once oral anticoagulant is restarted postoperatively.

3

47

Regional anesthesia can safely performed in in patients receiving anticoagulant or antiplatelet therapy provided that patient management is based on appropriate timing of needle placement and catheter removal relative to the timing of anticoagulant drug administration. True or false?

true

48

Indwelling catheters should not be removed in the presence of therapeutic anticoagulation, as this appears to significantly increase the risk of _____ _______.

spinal hematoma

49

What does this waveform indicate?

Q image thumb

hyperkalemia

50

What does this waveform indicate?

Q image thumb

hypokalemia

51

What EKG changes occur with hypocalcemia?

prolongs the QT interval

52

What  arrhythmia is associated with a prolonged QT interval?

torsades

A image thumb
53

What waveform is this?

What does this waveform indicate?

Q image thumb

Osborne Waves

severe hypothermia

Note: The rhythm is atrial fibrillation. Bradycardia is present. The QT/QTc is prolonged. 

54

What does this EKG depict?

 

Q image thumb

Digital effect. 

Note the downsloping ST segment.

Digitalis toxicity is commonly associated with dysrhythmias and AV nodal blocks.

55

What are the following waveforms?

Q image thumb

A image thumb
56

What can the following drugs cause to change in an EKG:

Sotalol
Quinidine
Procainamide
Disopyramide
Amiodarone
Dofetilide

prolonged QT interval

A image thumb
57

What can the following drugs cause to change in an EKG:

Tricyclic Antidepressants
Phenothiazines
Erythromycin
Quinolone antibiotics
Antifungal medications
* Droperidol & Zofran

A image thumb
58

What are the stages of pericarditis found within the EKG?

ST segment elevation

T wave inversion which occurs after ST segment moves back to baseline

Q waves do not occur in pericarditis and the PR interval is sometimes depressed.

A image thumb
59

Q waves do not occur in pericarditis and the PR interval is sometimes elevated. True or false?

false

depressed

60

What condition is indicated by:

left ventricular hypertrophy and left axis deviation
Q waves in lateral leads I, aVL, V5, and V6

Hypertrophic Obstructive Cardiomyopathy (HOCM)

61

What does this strip indicate?

Q image thumb

Hypertrophic Obstructive Cardiomyopathy (HOCM)

62

What does this strip indicate?

Q image thumb

myocarditis

Note: Any diffuse inflammatory process involving the myocardium can produce a number of changes on the EKG. Most common are conduction blocks especially bundle branch blocks & hemiblocks.

63

What does this strip indicate?

Q image thumb

COPD

Peaked p waves in leads II, III, aVF, and V1

right axis deviation

64

What changes will you see in a pulmonary embolus?

s waves in lead I

q waves in lead III

inverted t waves in lead III

A image thumb
65

Unlike an inferior infarction, in which Q waves are seen in at least two of the inferior leads, the Q waves in an acute pulmonary embolus are limited to lead III. True or false?

true

66

What do deeply inverted, wide T waves indicate?

Q image thumb

CNS bleed