Lecture 6- Preoperative Assessment Flashcards
1
Q
6 Elements of the Preoperative Assessment
A
Introduction:
Interview:
Exam:
Consent:
Vital Signs/Monitors:
Plan/Expectations:
2
Q
AANA Scope of practices has 5 parts what are they??
A
3
Q
3 AANA Standards for pre-operative assessment
A
- Standard I: Perform a thorough pre-anesthesia assessment
- Standard II: Obtain informed consent in a language the patient or legal guardian understands
- Standard III: Formulate patient-specific plan of care based upon comprehensive patient assessment
4
Q
ASA Preoperative Assessment Standards
I hope we don’t actually need this cause there’s a fuck ton
and most are common sense
A
- Review medical record
- Interview and conduct focused pt exam
- Review medical history
- Prior anesthetics and medications
- Obtain/review pertinent tests and consultations
- Paradigm is changing
- Determine preoperative medications
- Anxiolytic or possible opioid
- Antibiotics ordered by surgeon
- Check institutional policy for timing of administration
- Obtain anesthesia consent
- Document that pre-op assessment was completed in the chart
5
Q
name a few preoperative assessment settings
A
- Inpatient – ~ 30-40% of our patients present this way.
- Anesthesia Preoperative Evaluation Clinics
- Hospitalist/NP evaluation
- Same Day Admission
- Nurse-based assessments
- Outpatient (the other 60-70% of patients)
- Surgical Center
- Physician Office
- Pre-op telephone assessments- a must
6
Q
What does an Urgent Vs. Emergent procedure mean?
A
Hierarchy of case schedules
* Risk of vision, limb, fertility, organ MUST BE PRIORITIZED
- The in betweens are what makes it hard
7
Q
Medical Co-morbitities that warrant an early pre- anesthesia assessment:
General
A
o Poor ability to perform ADLs- lots of times done by pre-op will refer to early pre-anesthesia assessment
o Recent hospitalizations
8
Q
Medical Co-morbitities that warrant an early pre- anesthesia assessment:
CV
A
o History of angina
o Poorly controlled HTN
o CHF
o Recent MI
o Symptomatic arrhythmia- dat new a-fib tho CANCEL
9
Q
Medical Co-morbitities that warrant an early pre- anesthesia assessment:
Respiratory
A
o Asthma
o COPD
o Abnormal airway anatomy
o Major airway surgery
o Recent URI during flu seasons
10
Q
Medical Co-morbitities that warrant an early pre- anesthesia assessment:
Hepatic and Endocrine
A
- Hepatic
o Active disease (ascites) - Endocrine Disorders
o Diabetes- AIC trends
o Adrenal
o Thyroid
11
Q
Medical Co-morbitities that warrant an early pre- anesthesia assessment:
musculoskeletal
A
- Musculoskeletal- anything that will mechanically restrict the lungs
o Kyphosis
o Scoliosis- lungs is in a cage
o Severe TMJ
o Cervical or Thoracic Spine Injury = early assessment
12
Q
Medical Co-morbitities that warrant an early pre- anesthesia assessment:
GI and ONC
A
- Oncologic
o Current chemotherapy- neutropenic - GI
o Morbid obesity
o Hiatal hernia
o symptomatic GERD
13
Q
name the 3 phases and explain the 3 phases of the preoperative eval
A
- Review of the Medical Record
a. Ideally performed prior to the patient interview.
b. Provides a basis and direction for the patient interview and physical assessment. - Patient Interview
a. Gain trust and clarify items from the medical record. - Physical Exam
a. Conduct a thorough physical examination.
14
Q
Pre-Operative History Summary
these flashcards are killing my soul
A
- Identify self/patient
- Identify the planned surgical, therapeutic, or diagnostic procedure (OR schedule may not accurately reflect planned procedure)
o They have to tell you what they are getting done and who is doing it
o Pre-op may book it differently based on what tools the surgeon will want in the room
o Must be specifically listed and that it matches the CONSENT - Assess patient understanding of planned procedure
- Systematic review of medical problems
o Current medical problems
o Past medical problems - Past surgical and anesthesia history
o Will show blade, Mallampati, etc A GEM
15
Q
what will the current med history tell you about your anesthetic plan?
A
- Prescriptions – what they take, doses, time of last dose, reason for each- what they should’ve taken and SHOULD NOT
- Anticoagulants, Antidepressants (MAOI- serotonin syndrome),
Benzodiazepines (may need more if present),
Cardiac meds,
Narcotics (options with GA AND SPINAL),
Oral hypoglycemic agents and insulin,
Pulmonary, Nonprescription- OTC and Herbals
16
Q
Whats the worst med a patient could take before surgery and how would you treat it if they did?
A
ACE/ARBS cause PROFOUND hypotension that will not be treatable with the usuals
give VASO
17
Q
what meds should you take even if fasting before surgery?
A
- Antihypertensive medications
o Possible exception: procedures with major fluid shifts, or for patients who have medical conditions in which hypotension is particularly dangerous, discontinue ACEIs or ARBs before surgery. - Cardiac medications- MINUS ACE/ARB
- Antidepressants, anxiolytics, and other psychiatric medications
- Thyroid medications
- Birth control pills
- Eye drops
- Heartburn or reflux medications
- Narcotic medications
- Anticonvulsant medications
- Asthma medications
- Steroids (oral and inhaled)
- Statins
- Aspirin
insulins- d/c SHORT acting, DM1 should take 1/3 of their usual long acting
insulin pump peeps should continue their basal dose
Monoamine oxidase inhibitors Continue these medications and adjust the anesthesia plan accordingly.
18
Q
Should patients take aspirin before surgery?
A
o Continue where the risks of cardiac events is felt to exceed the risk of major bleeding (high-grade CAD or CVD)
o If reversal of platelet inhibition is necessary, aspirin must be stopped at least 3 days before surgery.
o In general, aspirin should be continued in any patient with a coronary stent, regardless of the time since stent implantation.
19
Q
What meds should patients not take on Day of Surgery?
A
Topical medications Discontinue on the day of surgery.
* Oral hypoglycemic agents Discontinue on the day of surgery.
* Diuretics Discontinue on the day of surgery - (exception: thiazide diuretics taken for hypertension, which should be continued on the day of surgery).
* Sildenafil (Viagra) Discontinue 24 hours before surgery.
* COX-2 inhibitors Continue on the day of surgery unless the surgeon is concerned about bone healing.
* Nonsteroidal anti-inflammatory drugs Discontinue 48 hours before the day of surgery.
* Warfarin (Coumadin) Discontinue 4 days before surgery, except for patients having cataract surgery without a bulbar block.
*
20
Q
What anticoagulant should be d/c’d 4 days prior to surgery
A
COUMADIN
21
Q
Who has the worst outcomes after surgery?
A
Us
jk
alcoholics
22
Q
Smoker: Tom, a 45-year-old man.
Smoking History: Tom started smoking at 18 and smoked a pack per day until he quit at age 38.
whats his pack years?
A
1pack/day×20years=1pack/day×20years=20packyears
Pack years: 20 pack years.
23
Q
Smoker: Sarah, a 50-year-old woman.
Smoking History: Sarah started smoking at 15 and has smoked two packs per day (40 cigarettes) continuously since she was 18.
whats her pack years
A
2packs/day×32years=2packs/day×32years=64packyears
Pack years: 64 pack years.
24
Q
how long should a pt have stopped smoking to see vascular benefits and decreased risk of complications
A
at least 8 weeks
IE not the night before peoples
25
what considerations would you think about if a patient likes the cocaine
* Cocaine in all forms- interferes w/ reuptake of norepi
o Know when and how much
o Exaggerated effects of pathways
26
which recreational drug increases the risk of intraoperative MI
Marijuana
27
what are the current BP guidelines
28
CNS/PNS pt interview- what should you know if they say YES
CENTRAL NERVOUS SYSTEM
* Seizure, Tremors, TIA, Stroke, Migraine Headaches, Neuromuscular Disease, Depression, Anxiety Disorder, S/S ↑ ICP &/Or Cerebral Ischemia, H/A, N/V, Pupillary Changes, HTN & Bradycardia, EKG Changes, GCS < 8 Intubation Required
PERIPHERAL NERVOUS SYSTEM
* Assess for Peripheral Neuropathy: Numbness, Tingling, Radicular Pain, Weakness-
o So you don’t get blamed for it
* Properly position to avoid aggravation of symptoms WHILE AWAKE to comfort
* Document presence pre-operatively so change in symptoms is not attributed to intra-op positioning
29
Patient Interview:
"Hey I've had a heart attack or sometimes i get chest pains"
What are you thinking?
* Angina: Stable versus unstable.
o Unstable angina = ↑ risk of peri-op MI.
o Incidence, precipitating factors, duration, control with medication WHAT MAKES IT HAPPEN
o Get yourself a pre-op EKG and monitor INTRA-OP
* Previous MI- time dependent
o > 6 months 6% re-infarction
o 3-6 months 15% re-infarction
o < 3 months 30% re-infarction but mortality rate 50%
o < 30 days: highest at-risk period
o ACC/AHA: wait 4-6 weeks after MI for elective procedure
30
where should you keep a patient's BP during Surgery
will def be a thing for the hypertensives of the world
* Evidence of end-organ damage
* ****use anesthetics to treat HTN during a case (remember +/- 20% of normal during surgery to preserve the brain)
31
What happens if a pt says they have abnormal heart beats in your interview?
* Presence and nature of any arrhythmia
o Atrial arrhythmia- cancel- need TEE to see if they have clot
o Controlled versus uncontrolled (rate <100)
o New onset: elective surgery postponed
* Ventricular arrhythmia- find source and reason (electrolytes??)
o Benign
o Malignant
32
Pt interview "I have a PPM"
now what
* Pacer or AICD
o Determine if patient is pacer dependent
o Age and type of pacer
o Use of Bovie
BOVIE is seen as native electrical activity
* Device may see BOVIE as native rhythm and STOP pacing = bad
* Magnets: Convert to Asynchronous Mode- magnet master app
o So many different options
o Current recommendations from CV sources refer the patient be evaluated by rep to get recommendations
33
which valvular heart disease would cause severe vasoplegia
won't tolerate induction or spinal
o Severe AS: 14 fold ↑ of sudden peri-op death
o Need constant forward flow- cannot tolerate big changes in BP
Cannot tolerate spinal either- vasoplegic shock
o Cardiac surgical evaluation prior to elective procedure
o Maintain NSR, SVR, BP and CO
o Avoid hypotension and bradycardia
34
clinical parameters for pts undergoing non cardiac surgery
Revised Cardiac Risk Index
35
what are the risk classifications to determine cardiac complication rate?
o Class I: no risk factors- 0.4%
o Class II: 1 risk factor 0.9%
o Class III: 2> risk factors 6.6%
o Class IV: 3> risk factors 11.1%
36
Should peeps get BB routinely for surgery?
honestly IDK she gave 2 examples
If they were on them already definitely continue
decision to start BB should be individualized weighing risk/benefit
37
PCI and Surgery Pathway and Surgery
Balloon angio
Bare ass metal
DES
38
AHA preoperative antibiotic coverage for ENDOCARDITIS***
o Adult Ampicillin 2gms IV/IM
o Children Ampicillin 50mg/kg IV/IM
o Penicillin Allergy
Adult Clindamycin 600 mg IV
Children Clindamycin 20 mg/kg
39
What are examples of diseases included in the respiratory system category?
COPD, emphysema, asthma
## Footnote
These conditions can be acute or chronic and are significant for respiratory health.
40
What is the most important risk factor for post-operative pulmonary complications?
Surgical site
## Footnote
Proximity to the diaphragm is also a critical factor influencing lung function.
41
What should be assessed in a patient with asthma before surgery?
Frequency of attacks, time since last attack, severity of attacks
## Footnote
Other factors include triggers, recent URI, degree of control, and use of inhalers or oral steroids.
42
List common triggers for asthma attacks.
* Allergens
* Upper respiratory infections (URIs)
* Stress
* Cold air
* Exercise
## Footnote
Identifying triggers can help manage asthma preoperatively.
43
What is the recommendation for COPD patients before going to the OR?
Give them supplemental oxygen
## Footnote
This is important for managing their respiratory status.
44
What symptoms characterize COPD?
* Dyspnea
* Coughing
* Wheezing
* Sputum production
## Footnote
Advanced disease may present with a barrel chest and pursed-lip breathing.
45
How does a recent upper respiratory tract infection impact pediatric patients?
Increases the risk of peri-operative complications 2-7 times
## Footnote
This is particularly true for patients under 1 year of age.
46
What should be avoided in adult patients with recent URI?
General anesthesia if possible
## Footnote
Laryngeal mask airway (LMA) is preferred over endotracheal tube (ETT) to reduce airway irritation.
47
What does the STOP-BANG questionnaire assess?
Risk factors for obstructive sleep apnea
## Footnote
It includes factors like history of cigarette use and ASA-PS scores.
48
What are some additive risk factors for postoperative pulmonary complications?
* History of cigarette use
* ASA-PS scores of 2 or more
* Age 70 years or more
* COPD
* Neck, thoracic, upper abdominal, aortic, or neurologic surgical procedures
* Anticipated prolonged procedures (≥2 hours)
* Planned general anesthesia
* Albumin concentration less than 35 g/dL
* Inability to walk two blocks or climb one flight of stairs
* BMI of 30 or more
## Footnote
The presence of multiple factors increases the chance of complications.
49
What gastrointestinal issues can affect surgical outcomes?
* Abdominal distention
* Obstruction
* Delayed gastric emptying
* Dysphagia
* Peptic ulcer disease and/or history of GI bleeding
* Hiatal hernia
* GERD
## Footnote
Severity of GERD may require daily treatment or pre-treatment before surgery.
50
What is a key strategy for managing Post-operative Nausea and Vomiting (PONV)?
TIVA (Total Intravenous Anesthesia)
## Footnote
Includes the use of a Propofol drip and avoidance of volatile anesthetics.
51
What is the recommended dosage for Propofol drip when receiving general anesthesia?
25 mcg/min- she just said this IDK if its official
## Footnote
This is advised if the patient is receiving general anesthesia.
52
List two medications used in multimodal treatment of pain for PONV.
* Scopolamine patch
* Decadron
* 5 HT3 blocker: Ondansetron
* H2 blocker: Famotidine
* H1 blocker: Benadryl
* NK1 blocker: Emend
## Footnote
These medications help manage pain and prevent PONV.
53
What are the two types of hepatobiliary disease mentioned?
* Acute disease
* Chronic disease
## Footnote
Includes conditions like Hepatitis and Cirrhosis.
54
What is a significant complication associated with renal system issues during surgery?
Renal Insufficiency
## Footnote
This can complicate drug metabolism and excretion.
55
What impact does dialysis have on potassium and volume?
* Good for potassium
* Bad for volume/anemia
## Footnote
Dialysis can help remove excess potassium but may worsen volume status or anemia.
56
What endocrine disorders require a medication management plan?
* Thyroid Disease
* Hyperthyroidism
* Hypothyroidism
* Adrenocortical Disorders
T1 DM
## Footnote
These conditions may need adjustments in medication before surgery.
57
What is a consideration for diabetic patients regarding surgery timing?
Morning case vs afternoon case
## Footnote
Afternoon surgeries can lead to hypoglycemia.
58
What type of insulin should be continued preoperatively?
Basal insulin (1/3-1/2 dose)
## Footnote
Prandial insulin is typically held.
59
What should be avoided in diabetic patients during the perioperative period?
* Ketoacidosis
* Hypoglycemia
## Footnote
These conditions pose serious risks during surgery.
60
What factors are associated with renal system issues?
* Hypertension
* Cardiovascular Disease (CVD)
* Increased intravascular volume
* Electrolyte disturbances
* Metabolic acidosis
## Footnote
These factors can complicate surgical outcomes.
61
What is a key factor to monitor in patients with diabetes during the perioperative period?
Frequency of intra-operative blood sugar checks
## Footnote
This is crucial for managing blood glucose levels.
62
What is obesity defined as?
> 20% above Ideal Body Weight (IBW)
## Footnote
Obesity is determined based on the individual's Ideal Body Weight, which is a standard measure to assess healthy body weight.
63
What is the formula for calculating Body Mass Index (BMI)?
BMI = kg/height in m²
## Footnote
This formula requires weight in kilograms and height in meters squared to determine BMI.
64
How do you convert inches to centimeters?
1 inch = 2.54 CM
## Footnote
This conversion is essential for calculations involving height when determining IBW or BMI.
65
What is the Ideal Body Weight (IBW) formula for women?
W: 105 + 5 lbs for each inch over 5ft
## Footnote
This formula provides a guideline for estimating a woman's ideal body weight based on her height.
66
What is the Ideal Body Weight (IBW) formula for men?
M: 110 + 5 lbs for each inch over 5ft
## Footnote
This formula provides a guideline for estimating a man's ideal body weight based on his height.
67
How is rough IBW estimated using height in centimeters?
Drop the 1 at the front of height in cm
## Footnote
For example, a patient who is 5’3” (160 cm) would have a rough IBW of 60 kg.
68
What does a BMI of 24 kg/m² indicate?
Normal weight range
## Footnote
A BMI of 24 kg/m² is typically considered within the normal weight range.
69
What does a BMI of 43 kg/m² indicate?
Obesity
## Footnote
A BMI of 43 kg/m² is classified as obesity, indicating significant excess body weight.
70
What are common symptoms of hematologic disorders?
* Bleeding tendency
* Easy bruising
## Footnote
These symptoms may indicate underlying blood disorders that require further investigation.
71
What therapies are associated with increased bleeding tendency?
Use of ASA/thienopyridine therapy
## Footnote
These medications can affect platelet function and increase the risk of bleeding.
72
What are some conditions that can lead to anemia or thrombocytopenia?
* Hereditary coagulopathies
* Sickle cell disease
## Footnote
These conditions can affect blood cell production or function, leading to lower levels of red blood cells or platelets.
73
What should be avoided in patients with sickle cell disease?
* Hypoxia
* Anemia
* Dehydration
## Footnote
Avoiding these conditions is crucial to prevent complications in patients with sickle cell disease.
74
What is the treatment for hemophilia?
Infusion of Factor VIII
## Footnote
Factor VIII is essential for blood clotting and its infusion helps manage bleeding episodes in hemophilia patients.
75
What is von Willebrand disease treated with?
* DDVAP
* Humate infusion
## Footnote
These treatments help increase levels of von Willebrand factor and improve clotting in affected individuals.
76
What is assessed in the level of consciousness during a physical examination?
Presence of neurological dysfunction and sensory or skeletal muscle dysfunction
## Footnote
Laughing instead of answering may indicate a lack of consent or altered mental status.
77
What general impressions are made in the cardiovascular system assessment?
Baseline heart rate and auscultation of chest
## Footnote
Includes checking for normal heart sounds and abnormal murmurs.
78
What are the abnormal sounds that may be heard during lung auscultation?
Rales, Rhonchi, Wheezing
## Footnote
Pre-op mini neb Rx may be considered.
79
What factors can make intubation more challenging?
Limited flexion/extension and presence of a neck mass
## Footnote
A neck mass can cause tracheal deviation.
80
What is the Mallampati classification used for?
Airway examination
## Footnote
It assesses the visibility of the oropharyngeal structures.
81
What are the characteristics of a normal airway in adolescents and adults?
* History of easy intubations
* Normal appearing face
* Normal clear voice
* Absence of scars, burns, or swelling
* Ability to lie supine asymptomatically
* Patent nares
* Ability to open the mouth widely
* Mallampati class I
* Adequate distance from mandible to thyroid notch
* Slender supple neck
* Movable larynx
* Normal profile appearance
## Footnote
These factors indicate an easier intubation process.
82
What is the incidence of difficult intubation in diabetic patients?
10 times higher
## Footnote
Limited joint mobility is present in 30-40% of IDDM patients.
83
What hand position may indicate limited mobility in diabetic patients?
Prayer sign
## Footnote
Patients may be unable to straighten the 4th and 5th fingers.
84
True or False: A history of radiation therapy to the head or neck is a characteristic of a normal airway.
False
## Footnote
A normal airway should have no history of radiation therapy.
85
Fill in the blank: The ability to open the mouth widely is a characteristic of a normal airway, defined as a minimum of _______.
4 cm or three fingers held vertically in the mouth
## Footnote
Good TMJ function is also necessary.
86
What is the normal extension angle for the atlantooccipital joint?
35°
## Footnote
This is important for assessing airway mobility.
87
What is a factor characterizing difficult airway related to sleep?
OSA / History of snoring
## Footnote
OSA stands for Obstructive Sleep Apnea, which is a condition that can complicate airway management.
88
What neck circumference indicates a potential difficult airway in men?
>17 inches
## Footnote
Increased neck circumference is a risk factor for difficult intubation.
89
What neck circumference indicates a potential difficult airway in women?
>16 inches
## Footnote
This measurement is critical in assessing airway difficulties.
90
What is the significance of thyro-mental distance in airway management?
Less than 7 cm with head in maximum extension
## Footnote
A smaller thyro-mental distance is associated with difficult intubation.
91
What does a higher Mallampati score indicate?
Increased difficulty in airway management
## Footnote
Mallampati scores assess the visibility of the oropharyngeal structures.
92
What term describes a large tongue that can complicate airway management?
Macroglossus
## Footnote
Macroglossus can obstruct the airway during intubation.
93
What is a risk factor related to previous medical history that complicates airway management?
Previous head and neck radiation
## Footnote
Radiation can lead to fibrosis and airway changes.
94
What congenital condition is associated with difficult airway management?
Down syndrome
## Footnote
Down syndrome can involve anatomical variations affecting the airway.
95
What is the Mallampati Class I?
P
## Footnote
This class indicates a potentially easier intubation.
96
What is the Mallampati Class IV?
H
## Footnote
This class indicates a more difficult intubation scenario.
97
What does the Cormack-Lehane scoring system evaluate?
Visibility of the glottis during laryngoscopy
## Footnote
It has four grades, with Grade 1 being the best visibility.
98
What indicates a difficult intubation in terms of thyro-mental distance?
Distance < 7 cm or 3 finger breadths
## Footnote
Short thyro-mental distance correlates with difficult airway.
99
What is the mandibular space's role during laryngoscopy?
Accommodates tongue
## Footnote
Proper space is needed for effective visualization.
100
What is the minimum sternomental distance for an easier intubation?
> 9 cm
## Footnote
This distance should be measured with the head in full extension.
101
What does the acronym BURP stand for in airway management?
Back, Up, Right, Pressure
## Footnote
This maneuver can improve glottic opening during intubation.
102
What is the interincisor distance used to assess?
Interdental gap
## Footnote
It helps in evaluating the ability to open the mouth for intubation.
103
What functional aspect does interincisor distance evaluate?
TMJ function
## Footnote
Temporomandibular joint function is crucial for mouth opening.
104
What position is evaluated for atlantooccipital function?
Sniffing Position
## Footnote
This position optimizes airway alignment for intubation.
105
What is the Upper Lip Bite Test (ULBT)?
A technique for airway evaluation
If they can’t do it = harder airway
106
What drives routine preoperative testing?
The patient's history and physical
107
What are the risks of unwarranted testing?
Costly, may delay operation, increase risk for unneeded interventions
108
When should diagnostic testing be indicated?
Only if it will correctly identify abnormality and change patient management
109
What is the Choose Wisely Campaign?
A multidisciplinary collaboration to reduce unnecessary, costly procedures
Like chest X-rays on everyone and their mother when there’s no indication
110
What are the ASA recommendations for pre-op testing in ASA I-II patients?
No baseline lab testing if blood loss and fluid shifts are minimal
111
What is the recommendation for diagnostic cardiac testing in asymptomatic stable patients?
No diagnostic cardiac testing in known cardiac disease patients undergoing low-mod risk non-cardiac surgery
112
What laboratory tests are commonly assessed preoperatively?
Hgb/HCT, coagulation studies, blood chemistries
113
What surgical issues necessitate Hgb/HCT testing?
* Large blood loss anticipated * Trauma
114
What patient history factors are important for coagulation studies?
* Increased bleeding * Hematologic disorders * Renal disease * Recent chemotherapy or radiation treatment * Use of anticoagulants
115
What are common blood chemistries assessed during preoperative assessment?
* Alcohol abuse * Cardiovascular disease * Renal disease * Diabetes: HbA1c * Malnutrition
116
What is the purpose of conducting an EKG preoperatively?
To identify high-risk patients with previous MI or arrhythmia
117
What is the value of EKG in asymptomatic patients?
Limited in detecting ischemia, poor predictor of peri-op complications
118
What are the ABCs of interpreting a Chest X-ray?
* A- Airways * B- Bones & soft tissues * C- Cardiac silhouette & Calcifications * D- Diaphragm * E- Effusions, Edges, ECG leads * F- Fields (lungs) & Foreign Bodies * G- Gastric bubble * H- Hila & mediastinum * I- Instruments, Impressions, Inference
119
What is the risk-benefit analysis for routine CXR in asymptomatic patients under 75 years?
Risk greater than the benefit
120
What are the key components of Pulmonary Function Tests?
* Forced Vital Capacity (FVC) * FEV1
121
What is the normal FEV1/FVC ratio?
> 0.7
122
FVC and FEV1
in. Airway obstructions: ie asthma bronchitis
FVC- normal
FEV1- Decreased
FEV1/FVC- Decreased
123
FVC/FEV1 in stiff lungs
| pneumonia, pulmonary edema, pulm fibrosis
FVC- Decreased
FEV1- decreased
FEV1/FVC- somehow normal
124
FVC/FEV1 with respiratory muscle weakness
| ie: Myasthenia gravis, myopathies
FVC- decreased
FEV1- decreased
FEV1/FVC- somehow normal again
125
What is the recommended hold period for daily GLP-1 receptor agonists before surgery?
Hold the medication on the day of surgery
## Footnote
Daily GLP-1 receptor agonists should be held on the day of surgery to minimize risks.
126
What is the recommended hold period for weekly GLP-1 receptor agonists before surgery?
Hold the medication for one week prior to surgery
## Footnote
Weekly GLP-1 receptor agonists should be held for a week before surgery.
127
What are traditional fasting periods before surgery?
No food, gum, or candy after midnight; clear liquids up to 2 hours pre-op
## Footnote
Traditional fasting guidelines include these restrictions to minimize aspiration risk.
128
What is the value of NPO after midnight?
Minimizes the risk of pulmonary aspiration
## Footnote
NPO (nil per os) is crucial for reducing aspiration risk during anesthesia.
129
List risk factors for pulmonary aspiration.
* Extremes of age
* Emergency cases
* Esophageal surgical history
* Recent meal
* Decreased gastric emptying
* Trauma
* Pregnancy
* Pain and distress
* Decreased level of consciousness
* Difficulty with airway
## Footnote
These factors increase the likelihood of regurgitation and aspiration during anesthesia.
130
What is the maximum time for clear liquids before surgery?
Up to 2 hours pre-op
## Footnote
Clear liquids such as water, black coffee, tea, and apple juice are allowed until 2 hours before the procedure.
131
How long before surgery can breast milk be consumed?
Up to 4 hours pre-op
## Footnote
Breast milk is permitted until 4 hours before surgery.
132
How long before surgery can formula be consumed?
Up to 6 hours pre-op
## Footnote
Formula is allowed until 6 hours before surgery.
133
What type of light meal is allowed up to 6 hours before surgery?
Tea/toast
## Footnote
A light meal such as tea and toast can be consumed until 6 hours before surgery.
Thank u ai
134
What medications should be taken before surgery?
All prescribed medications taken with a sip of water
## Footnote
Patients should take their prescribed medications with a small amount of water, even during fasting.
135
What condition can GLP-1 receptor agonists cause that increases the risk during anesthesia?
Nausea, vomiting, and delayed gastric emptying
## Footnote
These effects can increase the risk of regurgitation and aspiration.
136
What is the impact of chewing gum on gastric volume?
Can increase gastric volume
## Footnote
Chewing gum may lead to increased gastric contents, which is a consideration before surgical procedures.
137
True or False: Anxiety is a risk factor for pulmonary aspiration.
True
## Footnote
Anxiety can contribute to increased risk factors during anesthesia.
138
What condition is characterized by altered mechanically and increases aspiration risk?
Esophageal surgery
## Footnote
Previous esophageal surgery can change the anatomy and increase the risk of aspiration.
139
Fill in the blank: Conditions such as _______ and _______ can alter GI motility and increase aspiration risk.
[exogenous medications], [opioids]
## Footnote
Certain medications can affect gastrointestinal motility and increase the risk of aspiration.
140
What types of gastric contents increase the risk of aspiration?
* Solid food
* Milk products
## Footnote
The type and composition of gastric contents are critical factors in aspiration risk.
141
What are some metabolic disorders that increase pulmonary aspiration risk?
* Hypothyroidism
* Chronic diabetes
* Hepatic failure
* Hyperglycemia
* Obesity
* Renal failure
* Uremia
## Footnote
These conditions can affect gastric emptying and increase the likelihood of aspiration.
142
What is the significance of considering the potential impact of surgery proceeding earlier than scheduled?
It may affect the fasting status of the patient
## Footnote
Early surgery could lead to the patient not being adequately fasted, increasing aspiration risk.
143
List neurological sequelae that can increase the risk of pulmonary aspiration.
* Developmental delays
* Head injury
* Hypotonia
* Seizures
## Footnote
Neurological conditions can compromise airway protection and increase aspiration risk.
144
What age extremes increase the risk of regurgitation and pulmonary aspiration during anesthesia?
<1 yr or > 70 yr
145
List three conditions that increase the risk of pulmonary aspiration during anesthesia.
* Anxiety
* Ascites
* Collagen vascular disease
146
What is a common exogenous medication that alters GI motility and increases aspiration risk?
Opioid
147
True or False: The ASA Physical Status Classification System is based on surgical or anesthetic risk.
False
148
What does ASA 5 indicate regarding a patient's condition?
Needs OR or death
149
Identify two non-ASA status factors that influence patient outcome.
* Duration and invasiveness of procedure
* Human error
150
What factors should be considered when determining the anesthesia plan of care?
* Physical status of the patient
* Type, length, invasiveness of procedure
* Patient preference
* Anesthesia provider preference
* Surgeon preference
* 'What to expect'
151
What are some frequently occurring, minimal impact risks associated with general anesthesia?
* Oral or dental damage
* Sore throat
* Hoarseness
* PONV
* Drowsiness/confusion
* Urinary retention
152
List two infrequently occurring, severe risks associated with general anesthesia.
* Awareness
* Organ failure
153
What is a frequently occurring, minimal impact risk associated with regional anesthesia?
Prolonged numbness/weakness
154
Fill in the blank: Jehovah's Witnesses may refuse _______ for religious reasons.
blood products
Needed to have an easy one in there from time to time you’re welcome
155
What should be outlined before a treatment refusal occurs?
Religious reasons
156
Identify a life-threatening situation that may override patient rights.
DNR gets brought in AFTER the things happened emergently
157
True or False: A pregnant minor is not considered an adult.
False
158
What are the serious risks associated with anesthesia that should be disclosed?
* Serious risks
* Prevention and treatment of risk
159
What is the impact of failed spinal technique in regional anesthesia?
May require conversion to GA
160
What are Do Not Resuscitate (DNR) Orders?
Orders indicating that a patient should not receive resuscitation efforts in case of cardiac arrest.
## Footnote
DNR orders are often specific to the perioperative period and may require separate forms for patients going to the OR.
161
What is a common protocol regarding DNR orders in the operating room?
DNR orders may require separate documentation for patients knowingly going to the OR.
## Footnote
There may be ways to circumvent DNR orders in certain situations.
162
What types of consent documentation are recognized?
Written, verbal, or implied consent.
## Footnote
Each type serves different contexts and requirements.
163
What is the purpose of informed consent?
To ensure that patients understand the risks, benefits, and alternatives of a procedure before agreeing to it.
## Footnote
Informed consent is a legal and ethical requirement in medical practice.
164
What is required for consent of a minor child?
Consent must be obtained from a parent or legal guardian.
## Footnote
Minors are generally not considered capable of giving informed consent themselves.
165
How is consent obtained for a patient with altered level of consciousness (LOC)?
Consent must be obtained from a legally authorized representative or guardian.
## Footnote
Patients with altered LOC may not be able to provide informed consent themselves.
166
What considerations are there for consent of patients with limited intelligence?
Consent must involve a legally authorized representative or guardian, ensuring the patient understands as much as possible.
## Footnote
Special care must be taken to ensure the patient's rights and understanding.
167
What might prompt a change in anesthetic management?
Changes in the patient's medical condition or preferences during the perioperative period.
## Footnote
Informed consent should also cover potential changes in management.
168
how many CM is 1 inch
2.54 cm = 1 inch
