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Anesthesia Principles 1 > Pre-op Assessment > Flashcards

Pre-op Assessment Flashcards

(48 cards)

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1
Q

Risk of perioperative MI in general public

A

0.3%

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2
Q

Risk for reinfarction for patient with previous MI

A

> 6 months ago = 6%
3-6 months ago = 15%
< 3 months ago = 30%

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3
Q

Highest risk of reinfarction of MI is greatest _______.

A

within 30 days of acute MI

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4
Q

ACC/AHA guidelines to wait for elective surgery after recent MI

A

Wait 4-6 weeks

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5
Q

Greatest risk for non-cardiac surgery MI

A

Aortic Stenosis
-14X increase of perioperative mortality

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6
Q

What type of angina increases a pts risk for an MI with surgery and anesthesia

A

Unstable Angina

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7
Q

METS are a quick way to assess

A

CV function
-** you want at least 4 METs (Can you walk up a flight of stairs without getting short of breath?)

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8
Q

Risk of pulmonary complications increases as surgical site approaches the _______.

A

diaphragm and increased length of surgery (>2-3 hrs.)

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9
Q

OSA pearls

A

-can make pts difficult to mask ventilate
-have them bring CPAP for PACU
-don’t extubate deep
-minimize opioids and versed use

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10
Q

Asthma patient can have _______ preoperatively.

A

BRONCHOSPASM
-Have pt use their inhaler prior to induction

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11
Q

Red Flag for asthmatic pt

A

recent asthma attack!

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12
Q

High risk for aspiration equals _______.

A

RSI

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13
Q

Aspiration risks

A

-Small bowel obstruction
-Active nausea and vomiting
-GERD
-Hiatal hernia
-DM
-Ascites
-Pervious gastric bypass (DO NOT PUT NG or OG in these pts)
-Obesity
-Pregnancy

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14
Q

What is Mendelson syndrome?

A

chemical pneumonitis due to aspiration

-Aspirate Gastric Volume- >25mL
-pH <2.5
-Particulate aspirate > clear aspirate

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15
Q

DM general rules

A

-Hold oral diabetic medication morning of surgery (metformin 48 hours prior to surgery)

-Take ¼- ½ of insulin

-Check BG upon arrival and intra-op if procedure is long

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16
Q

What is Pheochromocytoma?

A

Hypersecreting tumors that secrete excess catecholamines

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17
Q

Catecholamines secreted from Pheochromocytoma

A

Primarily norepinephrine and some epinephrine

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18
Q

S&S of Pheochromocytoma

A

-Paroxysmal hypertension, Triad of diaphoresis, tachycardia, and headache, Tremulousness, Weight loss, Decreased intravascular volume, Orthostatic hypotension, HCT >45%

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19
Q

Surgical Hx concern for difficult intubation

A

-neck dissection
-laryngeal surgery (CA +radiation, chemo)
-previous trach
-c-spine surgery

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20
Q

How long to reduce acute effects of nicotine?

21
Q

How long for smokers to have better pulmonary mechanics

22
Q

Acute cocaine use =

Study These Flashcards
A

DON’T give beta-blocker, use calcium channel blocker instead

23
Q

Marijuana use=

Study These Flashcards
A

more anesthesia, increased airway reactivity

24
Q

Narcotic use =

Study These Flashcards
A

more anesthesia and increased opioid requirement d/t increased tolerance

25
ASA classes
1- healthy 2- BMI 30-40 3- BMI >40 4- Surgery is constant threat to life; CVA, TIA, MI <3 months, 5- NEED surgery to survive; AAA, trauma, MODS 6- brain dead, organ donor
26
27
Most common cause of intraop allergic reaction
Rocuronium
28
IV contrast dye and protamine cross reactivity
Shellfish
29
Do not stop for surgery (reduces risk of peri-op ischemia
Beta-blockers
30
Increases bleeding
garlic, ginkgo biloba, ginseng, fish oil
31
Decrease anesthesia needs:
kava kava, valerian root
32
ASA hold time
7 days
33
NSAIDs hold time
24-48 hours
34
Clopidgrel
5-7 days
35
When do always get platelet count?
Spinal or epidural
36
NPO guidelines
37
STOP-BANG
38
PUSH
39
Laryngoscopy may be more difficult if the TMD is _______.
less than 6 cm (3 finger breadths) or greater than 9 cm
40
Less than 6 cm (TMD)
-mandibular hypoplasia -small mandibular space
41
Greater than 9 cm (TMD)
-larynx more caudal
42
Mandibular Protrusion Test (Upper Lip Bite Test)
43
The ability to place the patient into sniffing position is highly dependent on the mobility of the _______.
Atlanta-occipital joint
44
Normal AO flexion and extension
90-165 degrees
45
Normal AO extension
35 degrees (laryngoscopy will be difficult if < 23 degrees)
46
3-3-2 rule
-inter-incisor gap < 3 finger breadths -thyromental distance < finger breadths -Thyrohyoid < 2 finger breadths
47
Conditions that impair AO mobility
-degenerative joint disease -rheumatic arthritis -ankylosing spondylitis -trauma -surgical fixation -klippel-feil -Down syndrome -DM
48
Pneumonics

Anesthesia Principles 1 (11 decks)

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