Perioperative Management

Question 1

ASA classification higher than class ___ (meaning class ___ and above) means _____ times increased risk for post op pulmonary complications

Answer 1

Higher than class II.
Meaning class III and above.
= 2-3 x increased risk

Question 2

ASA Classification
I
II
III
IV
V
VI

Answer 2

I. healthy
II. mild or severe but controlled (controlled diabetes)
III. severe
IV. severe and threat to life
V. moribund patient who cannot survive without surgical attempt.
VI. braindead

Question 3

For patients with uncontrolled asthma or COPD, consider what in post-op period?

Answer 3

inhaled bronchodilators, corticosteroids, chest PT (physical therapy)

Question 4

If a patient has a pacemaker then be mindful of

Answer 4

cautery risk

Question 5

Maintain glucose at

Answer 5

80-100 mg

Question 6

Glucose med control for diabetes

Answer 6

Type I- do NOT stop basal insulin before surgery

Type II- hold orals before surgery

Question 7

Metformin peri-op control

Answer 7

stop 48 hours before and restart 48-72 hours after

Question 8

Pre-op Creatinine levels of ___ increase risk for acute renal failure

Answer 8

> 2.0

Question 9

Dialysis to be performed ___ day prior to surgery unless emergent

Answer 9

1 day

Question 10

PAD increases risk of post-op complications by ___ times

Answer 10

6 times

Question 11

Supplement pre-op steroids if patient has taken steroids for…

Answer 11

more than 2 weeks in last year

Question 12

Rheumatoid patients, order

Answer 12

cervical x-ray to assess atlantoaxial subluxation

Question 13

Bupivacaine duration vs Lidocaine

Answer 13

4-8 hrs vs 1-2 hours

Question 14

Toxic doses Bupivacaine

Answer 14

plain 175 mg
don’t exceed 2.5 mg/kg

w/epi 225 mg
don’t exceed 3.2 mg/kg

note Bupivacaine comes in 0.5%

Question 15

Equation for % to mg to cc conversation

Answer 15

1% = 10mg/1cc(mL)

Question 16

Toxic doses Lidocaine

Answer 16

plain 300 mg
don’t exceed 4.5 mg/kg

epi 500 mg
don’t exceed 7.5 mg/kg

Question 16

How many cc’s of 1% Lidocaine plain can you give?

Answer 16

1% = 10mg/1cc
1% = 300 mg/ (x) cc

x = 30 cc

Question 17

How many cc’s of 1% Lidocaine w/epi can you give?

Answer 17

1% = 10mg/1cc
1% = 500 mg /(x) cc

x = 50 cc

Question 18

How many cc’s of 2% Lidocaine plain can you give?

Answer 18

1% = 10mg/1cc
2% = 300mg/ (x) cc
1% = 150 mg/ (x) cc

x = 15 cc

Question 19

Don’t use this local anesthetic in children bc it can disrupt growth plates

Answer 19

bupivacaine

Question 20

How many cc’s of 2% Lidocaine w/epi can you give?

Answer 20

1% = 10mg/1cc
2% = 500 mg / (x) cc
1% = 250 mg / (x) cc

x= 25 cc

Question 21

Local anesthetic systemic effects

Answer 21

excitation, convulsions, arrhythmias, methemoglobinemia (rare blood disorder that affects how red blood cells deliver oxygen throughout your body)