Pre-op Assessment Flashcards by Heather Lassiter

Pre-op labs are often ____ (under / over) ordered

Over

How well did you know this?

Not at all

Perfectly

Current recommendations for pre-labs (in general)

Selective ordering

How well did you know this?

Not at all

Perfectly

When to order

Hb / Type and Cross

If you anticipate major bleed

To obtain a baseline

How well did you know this?

Not at all

Perfectly

When to order

Urine PG test

All women of childbearing age

How well did you know this?

Not at all

Perfectly

When to order

Renal and Liver function

Based on medical hx

ie alcoholic

How well did you know this?

Not at all

Perfectly

When to order

Coags

Based on medical hx (ex - liver dz)
Type of procedure planned
Medications

How well did you know this?

Not at all

Perfectly

When to order

Cardiac Testing

Baseline EKG above 50 yo
Sx-related RF
Pt-related RF

How well did you know this?

Not at all

Perfectly

Sx-related predictors for risk of perioperative cardiac complications - High Risk

Emergency Sx
Anticipated increased blood loss
Aortic or perpheral vascular sx

How well did you know this?

Not at all

Perfectly

Sx-related predictors for risk of perioperative cardiac complications - Intermediate Risk

Abdominal or throacic sx
Head and neck sx
Carotid endarterectomy
Orthopedic sx
Prostate sx

How well did you know this?

Not at all

Perfectly

Sx-related predictors for risk of perioperative cardiac complications - Low Risk

Breast sx
Cataract sx
Superficial sx
Endoscopy

How well did you know this?

Not at all

Perfectly

Pt-related predictors for risk of perioperative cardiac complications - Major Clinical Predictors

MI = 6 weeks previously
Unstable angina
Decompensated CHF
Significant arrhythmias (eg causing hemodynamic instability)
Severe valvular dz (eg aortic or mitral stenosis with valve area <1.0 cm*cm)

How well did you know this?

Not at all

Perfectly

Pt-related predictors for risk of perioperative cardiac complications - Intermediate Clinical Predictors

Mild angina pectoris
MI > 6 weeks previously
Compensated CHF
DM

How well did you know this?

Not at all

Perfectly

Pt-related predictors for risk of perioperative cardiac complications - Minor Clinical Predictors

Advanced age
Abnormal EKG
Cardiac rhythm other than sinus
Low functional capacity
Hx of stroke
Uncontrolled HTN

How well did you know this?

Not at all

Perfectly

METs

Metabolic equivalents

One MET is the energy it takes to sit quietly

How well did you know this?

Not at all

Perfectly

METs scoring

> 7 - Excellent
4-7 - Moderate
<4 - Poor

How well did you know this?

Not at all

Perfectly

Activities of an excellent METs score

Playing squash
Jogging 10 min mile
Scrubbing floors
Singles tennis match

How well did you know this?

Not at all

Perfectly

Activities of a moderate METs score

Study These Flashcards

Cycling
Playing golf (no cart)
Walking (4 mph)
Gardening

Activities of an poor METs score

Study These Flashcards

Vacuuming
ADLs
Walking 2mph
Writing

General guideline for Pre-op

Study These Flashcards

Pts who are poor functioning or high risk should get a stress test
Pts with positive stress test results warrant cardiology consultation before proceeding wit sx
Pts with major clinical predictors usually warrant cardiology consultation preop

Pulmonary complications in peri-operative period

Study These Flashcards

Atelectasis
Pneumonia
Bronchitis

Predisposing pulmonary RF include

Study These Flashcards

Cough
Dyspnea
Smoking
Hx of lung dz
Obesity
Abdominal / Thoracic sx

Most significant pulmonary RF is

Study These Flashcards

The site of sx - abdominal / thoracic sx

As a rule, the closer the sx is to the diaphragm, the higher the risk of pulmonary complications

Indicators of increased surgical risk for pulmonary complications

Study These Flashcards

Cough
Dyspnea
Pulmonary dz
Smoking obesity
Abdominal/thoracic sx
FEV1 < 2L
MC V < 50% of predicted value
PEF < 100 L or 50% of predicted value
PCO2 >/= 45 mm Hg
PO2 = 50 mm Hg

Pulmonary Testing - Pre-op

Study These Flashcards

Baseline CXR in >50yo and in at-risk pts
PFT in select cases
Pre-op guidelines do not define the degree of pulmonary function impairment that would prohibit sx (*other than that for lung resection)

Malnutrition increases surgical ____ and ____.

Morbidity Mortality

Pre-op H and P should include assessment of RF or malnutrition, including

Social isolation Limited financial resources Poor dentition Weight loss, etc.

True or False | The best means of defining nutritional status has not been established.

True

_____ has been shown to correlate with post-op morbidity.

Albumin

What serum albumin level can signify increased risk of post-op complications?

3.2 g/dl

In what manners may pre-op nutritional supplementation be provided?

Orally Enteral tube feeding Parenteral nutrition

Oral Hypoglycemic agents and sx

Hold the morning of sx Metformin - notorious, can cause lactic acidosis post-op Insulin sliding scale peri-op and post-op

Insulin - Pre-op

Hold PM long-acting insulin (lantus), since NPO Hold AM dose Check glucose in pre-op and dose accordingly If pt feels hypoglycemic, sips of juice (clear liquid) or IV if inpatient

Anticoagulants - Pre-op

Stop Plavix 7 days pre-op if possible Postpone elective sx if not possible ASA - depends on procedure (neurosx or retinal sx; vs. umbilical hernia or carotid endarterectomy) Stop coumadin 3-5 days preop Bridge with Lovenox (Lovenox only lasts 12-24h, depending on dose)

68yo F with esophageal cancer, tolerating only liquids for the last month, 20 lb wt loss. What labs would you check? What are you worried about and why? How would you optimize her preop?

Nutritional status Malnourishment b/c she has not been eating for a month Tube feeding - J-tube in this case (G Tube vs. J Tube)

83yo F who had an MI last week. Smokes and can't go up 1 flight of stairs. MET =1. Cardiology has not cleared her for sx, presents wit ha perforated ulcer with free air. Would you operate?

NO!!! | She will die as soon as you put her under

42yo M with uncompensated CHF, referred to you for excision of a lipoma. What would you do?

Consult the cardiologist | This is an elective sx.

67yo M on coumadin for A.fib, presents for screening colonscopy. How would you manage his anticoagulation prior to the procedure?

Give lovenox | 1 mg/kg/day

70yo F just had a coronary stend placed and is on asa/plavix. Presents for a ventral hernia repair. What would you do?

She cannot stop the blood thinners b/c her stent was just placed. Wait at least 6m-1y to consult cardiologist about stopping blood thinning medication for this procedure

55yo M on lifelong coumadin for recurrent DVTs presents to t trauma bay s/p motorcycle accident. INR = 4.2. He needs an exploratory laparotomy for intraperitoneal injuries. How would you handle his INR? Do you reverse him prior to going to OR?

Give FFB You can reverse and go to the OR at the same time.

34yo M, healthy is referred for excision of a large melanoma on the back. What pre-op labs do you order? Any other pre-op tests?

No pre-op labs needed No other pre-op testing needed

66yo F, otherwise healthy. Referred for cholecystectomy. What pre-op labs do you order? Any other pre-op tests?

No pre-op labs needed EKG and CXR should be ordered

65yo M with lung ca. You plan on doing lobectomy. | What tests do you order pre-op?

``` CXR EKG Type and Cross Albumin PFT ```

Pre-op Assessment Flashcards

(42 cards)