Day 3-Systemic Health Considerations Flashcards
(36 cards)
Name that ASA status: 1 flight of stairs or 2 level city blocks without distress = SOB, undue fatigue, chest pain…..Anesthetic? Vasoconst?
ASA I…Yes…Yes
Name that ASA status: Must rest at top of flight of stairs Treatable with consideration for treatment modification (Type II Diabetes, Asthma,Epilepsy, and high BP (140-159/90) all well controlled….Anesthetic? Vasocon?
ASA II….Yes…Yes
Name that ASA status: Severe systemic disease that limits activity, but is not incapacitating..Must stop to rest before reaching top of the flight of stairs Treatable, with SERIOUS consideration for treatment modification….Anesthetic?….Vasocon?
ASA III….Yes…Yes (limit 0.04 epi)
What ASA status is a pt with an MI MORE THAN 6 months ago?
ASA III (ASA IV if
What ASA status is a Pt with STABLE angina?
ASA III
What ASA Status is a Pt with a BP of 180-199/105-114?
ASA IIIb (WOW)
Name that ASA status: Incapacitating systemic disease that is a constant threat to the patient’s life….Anesthetic? Vasocon?
ASA IV…Yes….NO (if status is based on CVD)
Name that ASA status: Moribund patient, not expected to survive 24 hours Hospitalized, “no code“- DNR…Anesthetic? Vasocon?
ASA V…Yes (palliative)…NO (if CVD)
What are the three categories of CNS drugs that we need to be careful for interactions with LA? (Thee three A’s) Whats the game plan?
Anticonvulsants, Antipsychotics, Antidepressants….just stay away from higher doses
What type of antidepressants can ENHANCE the CV actions of vasopressors? Which two vasopressors have the most interaction? By how much?
TriCyclic’s….Levonordephrine and Norepinephrine have a 5-10x enhancement of the Tricyclics…only 2x with epi!
Which drug class that WE may Rx for anxiety has interaction with the anesthetic?
BENZOs! (limit the LA dose)
Which class of drugs are we concerned about keeping the STRESS of LA down? What can we do to combat this?
Glucocorticoids….risk of adrenal crisis c/o no endogenous stress response….give N2O or use IV sedation
What is the ONLY H2 receptor blocker (heartburn/ulcers) that has interactions with lido?
TAG-A-MET….it competes with lido for biotransformation and leaves lido in the system longer
Combining LA agents together may be done safely… Toxicity risk is ______
additive
Sedation with _______ analgesics may increase risk of developing LA overdose…Risk is greater in CHILDREN Minimize dose of LA
OPIOID
Who is at risk for vasopressor interaction with beta blockers? (like what TYPE of beta blockers)…..What is the risk?
NON-selective beta blockers….risk is having a hypertensive event and secondary bradycardia
How do I tell if a Pt is on a NON-selective Beta blocker or a cardio-selective beta blocker? What is the only exception?
A-M = Cardio-selective…..N-Z= Non-selective…LAB-ET-A-LOL is the exception…its NON-selective
Increased risk for ________ when patients receiving certain ________ general anesthetics (eg. Halothane) are given ________ (LA or Epi?)
arrhythmias…..halogenated…EPI
What are the two Street drugs that are going to cause SNS effects when paired with EPI? How long do we need to wait? is this a relative or absolute contraindication?
Cocaine and Methamphetamine….wait 24hrs…ABSOLUTE contraindication
What can EtOH use do to LA?
Decrease its effectiveness..also can cause LA OD
CONGESTIVE HEART FAILURE: Pts may be on ________ (_____) which when mixed with EPI can cause arrythmias
cardiac glycosides (digoxin)
CONGESTIVE HEART FAILURE: What other organ do we need to be concerned with in these Pt when considering clearance of LA?
KIDNEY function
CONGESTIVE HEART FAILURE: If a pt is ASA IV SYMPTOMATIC, then dental Tx is ________
contraindicated
Since Sickle cell anemia has “_____” episodes we will not do dental Tx then…which part of our LA do we need to consider the most?
crisis…LIMIT the vasoconstrictors!! (plain drugs PREFERRED!)
