Pre Operative 2

Question 1

What u should do before deciding if patient can go or not to surgery?

Answer 1

After history, physical examination, investigation

Question 2

What is the criteria of patient that ready for surgery?

Answer 2

1- he fits anaesthesia
2- optimized physical condition
3-almost possible correction
4-high emergent
5- pt gives legal consent

Question 3

When u till the patient to postpone the surgery?

Answer 3

1-not fit the anaesthesia
2-ont optimized physical condition
3-not not almost possible correction
4-not emergent
5- have no legal consent

Question 4

How many classes in ASA??

Answer 4

6

Question 5

رتب
1-sever systemic disease ( sDM, COPD) 
2-healthy mormally patient
3-mild systemic disease
4- declared brain dead
5-incapacitating systemic disease
6-moribund patients not expected to survive 24hrs

Answer 5

CLASS lll
Class I
Class II
CLASS E
CLASS IV
CLASS V

Question 6

In general, what is pre operative optimization?

Answer 6

1. Any fluid or electrolyte imbalance should be corrected
2. Extent ot existing comorbidities should understood, condtions should be optimized prior to surgery
3. Medications need adjustment

Question 7

Enumerate steps of pre operative optimization of medications?

Answer 7

Pre operative medications to
1. Conseder
Stop
Adjust

Question 8

Enumerate preoperative medications to stop?

Answer 8

1. ORAL ANTIHYPERGLYCEMIC DRUGS
2. ACEIS AND ARB
3. WARFARIN AND HEPARIN
4. NSAIS AND ASPIRIN
5. HERBAL SUPPLEMENTS

Question 9

Enumerate pre operative medications to consider?

Answer 9

Prophylaxis :

1. GE REFLUX : RANITIDINE, METOCLOPRAMIDE, NA CITRATE
2. ANTIBIOTICS : INFECTIVE ENDOCARDITIS
3. STEROIDS FOR ADRENAL INSUFFICIENT
4. ANXIETY :BENZODIAZEPINES
5. BRONCHODILATOR: COPD AND ASTHMA
6. NITROGLYCRIN and B BLOCKERS FOR CAD

Question 10

To adjust??

Answer 10

BRONCHODILATOR
PREDNSONE
Insulin ( insulin)/dextrose infusion or holding dose

Question 11

Which diseases complications continue to account for major morbidity and
mortality in patients undergoing noncardiac surgery?

Answer 11

Cardiovascular and pumonary complications

Question 12

Which blood pressure not independently risk factor for perioperative cardiovascular complications?

Answer 12

Systole less than 180

Diadtole < 110

Question 13

Clarify pre operative optimization of CAD???

Answer 13

➢At least 60 day should elapse after a MI before a noncardiac surgery in the absence of a
coronary intervention
• This period carries an increased risk of re-infarction/death
➢Mortality with perioperative MI is 20-50%

Question 14

What are the advantages and disadvantages s of b blocker in CAD patient!

Answer 14

Dicrease the risk of cardiac events and mortality rate.

Increase peri operative strokes

Question 15

Continue -blocker if patient is…….

Answer 15

routinely taking it prior to surgery

Question 16

Consider initiation of -blocker in????

Answer 16

1.CAD and other ondications

2 intermediate and high risk surgerys as vascular surgery

Question 17

Enumerate high Risk factor assessment of Noncardiac Surgical Procedurs?

Answer 17

1. high emergent with elderly 🧓
2. prolonged surgery with high fluid shift/blood loss
3. aortic and other non carotid vascular surgery ( endovascular and non endo…)

Question 18

Enumerate lower Risk factor assessment of Noncardiac Surgical Procedurs?

Answer 18

Eye 👁‍🗨
Skin
Superficial surgery
Endoscopic procedures

Question 19

Enumerate intermediate Risk factor assessment of Noncardiac Surgical Procedurs?

Answer 19

1. head and neck 🧣
2. Carotid endartrectomy
3. Thoracic
4. abdominal
5. Orthopedic 🍖
6. Prostate

Question 20

Enumerate adverse effects of smoking?

Answer 20

🚬

1. Alter mucous secretion
2. Dicrease small airway calibre
3. Alter o2 carrying capacitiy
4. Increase airway respond
5. Alter immune response

Question 21

When the patient abstain smoking before surgery!

Answer 21

8 weeks

At least, 24 hrs enough to increase o2 availability in tissue

Question 22

What asthmatic patients need before surgery??

Answer 22

1. Short course of ( corticosteriods+ B2 AGONIST INHALATION)
2. Avoiding NON SELECTIVE B BLOCKER
3. CAN TAKE CARDIOSELECTIVE B BLOCKER

Question 23

Enumerate 2 of CARDIOSELECTIVE b blocker?

Answer 23

Metoprolol

Atenolol

Question 24

When asthmatic patients should delay surgery???

Answer 24

1** Poorly controlled asthma
(COGH, HIGH SPUTUM PRODUCTION, ACTIVE WEEZING)
2** URTI

Question 25

Asthmatic patients with URTI should delay surgery for...........

Answer 25

6 weeks

Question 26

Enumerate condtions exacerbate COPD patients?? | Then the their effects???

Answer 26

``` Anaesthesia Upper abdominal surgery Pain .......... Atelctasis Bronchospasm Pneumonia Prolonged mech ventillation Respiratory faliure ```

Question 27

Investigación should COPD patients do pre operative??? And why!!

Answer 27

ABG, to knlw baseline respiratory acidosis, plan the post operation management

Question 28

Which types of COPD need ABG?

Answer 28

II | III

Question 29

When COPD patients should cancel or delay the surgery??

Answer 29

Acute exacerbation

Question 30

Enumerate factors increase risk of aspiration!?

Answer 30

1. ⬆️ Intra abdominal pressure 2. ⬇️ Gastric emptying 3. Spheincter incompetence 4. ⬇️ Level of consciousness 5. Unprotected airway

Question 31

How to manage aspiration??

Answer 31

1. Manage risk factors if possible 2. ⬇️ Gastric volume and acidity 3. Protect airway(endotracheal tube) 4. Delay inhibiting air way reflexes with MS relaxants 5. Empoly rapid sequence induction

Question 32

Enumerate fasting guidlines prior to surgery!

Answer 32

* 8 h after a meal that includes meat, fried or fatty foods * 6 h after a light meal (such as toast or crackers) or after ingestion of infant formula or nonhuman milk * 4 h after ingestion of breast milk * 2 h after clear fluids (water, black coffee, tea, carbonated beverages, juice without pulp)

Question 33

Put examples on : | ⬇️ Level of consciousness??

Answer 33

CNS PATHOLOGY HEAD TRUAMA Shock/truama DRUGS/ALCOHOL

Question 34

Put examples on : | ⬆️ Abdominal pressure??

Answer 34

PREGNANCY 🤰 OBESITY BOWEL OBSTRUCTION ACUTE ABDOMEN

Question 35

Put examples on : | Delayed gastric empty??

Answer 35

DM NARCOTICS Non FASTED WITHIN 8 HRS

Question 36

Put examples on : | ⬇️ Sphincter competance

Answer 36

``` GERD Hiatus hernia Nasogadtric tube Pregnancy 🤰 OBESITY ```

Question 37

In hematological disorders evaluate...........

Answer 37

Hb Hematocrite Coagulation proles

Question 38

In case of Anemia, preoperative treatment is......?? And by......???

Answer 38

⬆️ Hemoglobin PO, IV iron supplements Erythropoiten Pre admission blood collection

Question 39

In coagulapathies, pre operative treatment is to stop........... And may need to take..........

Answer 39

``` Anticoagulants( warfarin, Aspirin, apixaban, clopidogrel, dabigatran) Reversal dugs( VIT. K, recombenant factor VII, prothrombin complex concentrats) ```

Question 40

In case of DM, be aware of end organ damage to...............?

Answer 40

CVS ♥ Renal preiphral, central and autonomic nervous sys🧠

Question 41

Enumerate pre operative guidlines for DM!!?

Answer 41

1. Verify target bl. Glucose ( ⬇️180 in critical cases,, ⬇️ 140 in stable cases) 2. Insulin therapy 3. Stop oral hypoglycemic drugs 4. Cancel non emergent procedures if glucose > 400, HHS, DKA

Question 42

Treatment of hyñerthyroidism pre operative??

Answer 42

B blocker | Prophylactic ⚕

Question 43

Both obesity and.............. Independently ⬆️ risk of............,.........,.........

Answer 43

OSA 1. difficult ventillation, intubation 2. post operative resp. Complications

Question 44

Hyper thyroidism can experience......... If not........... Pre operative.

Answer 44

Thyroid storm | Treated or well controlled

Question 45

Thank you

Answer 45

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