PreOp Eval Flashcards
Components of an anesthesia HPI
Pts
- age
- gender
- surgical diagnosis of …
- pertinent pmhx of …. controlled with …..(meds)
- scheduled for procedure …..
- with Dr.
- on date …..
- at … (facility)
What are the components of anesthesia social hx
Should include risk factors for disease
- tobacco use
- alcohol use
- substance use
All with qualifiers including
- frequency
- duration of use
- last use
What are social determinants of health
- Non medical factors that influence health outcomes
Including - housing
- transportation
- employment
- access to care
What are the components of anesthesia fam hx
- hx malignant hyperthermia
- atypical plasma pseudocholinesterase
Anything that will affect anesthesia care
What are METS
Metabolic equivalents of physical activity. Gives an indication of a pts ability to tolerate surgery given their baseline exercise/ activity tolerance
ASA I
Normal healthy patient
For adults
- healthy, non smoking, minimal etoh
For peds
- healthy, normal BMI percentile for age
ASA II
Mild systemic disease with no functional limitations
- well controlled diabetes
- well controlled HTN
- pregnancy
- BMI >30 but <40
- mild lung disease
- current smoker , social alcohol
ASA II Peds
- asymptomatic congenital cardiac disease
- well controlled dysrhythmias
- asthma without exacerbation
- well controlled epilepsy
- non insulin dependent DM
- mild OSA
- oncologic state in remission
- autism with only mild limitations
ASA II obstetric
- normal pregnancy
- well controlled gestational HTN
- controlled preeclampsia without severe features
- diet controlled gestational diabetes
ASA III
Severe systemic disease + functional limitation
- one or more systemic diseases like
- poorly controlled DM or HTN
- COPD
- morbid obesity BMI >40
- Active hepatitis
- implanted pace maker
- etoh dependency or abuse
- moderately low EF
- ESRD on dialysis
- 3 months of mor hx of MI, CVA, TIA CAD with stents
ASA III peds
- uncorrected stable congenital cardiac disease
- asthma with exacerbation
- poorly controlled epilepsy
- insulin dependent diabetes
- morbid obesity, malnutrition
- severe OSA
- CF
- Muscular dystrophy
- hx of organ transplant
- spinal cord malformation
- sever autism
ASA III obstetrics
- preeclampsia with sever features
- gestational diabetes with complications or high insulin requirements
- thromboembolic disease requiring anticoagulation
ASA IV
Severe systemic disease that is a constant threat to life
- recent MI CVA TIA CAD w/ stents < 3 mos
- ongoing cardiac ischemia
- severe valve dysfunction
- low EF
- shock
- sepsis
- ESRD not undergoing frequent dialysis
-
ASA IV peds
- symptomatic congenital cardiac abnormalities
- congestive heart failure
- active sequelae of prematurity
- DIC, sepsis, shock
-ventilator dependence - endocrinopathy
- advanced oncologic state
- severe respiratory distress
ASA IV obstetrics
- preeclampsia with severe features complicated by HELLP
- peripartum cardiomyopathy with EF <40
- decompensated heart failure
ASA V
Moribund will not survive without surgery
- ruptured AAA
- massive trauma
- intracranial bleed with mass effect
- ischemic bowel + cardiac pathology or multi organ system failure
ASA V peds
- massive trauma
- intracranial hemorrhage with mass effect
-pt requiring ECMO - respiratory failure or arrest
- malignant hyperthermia
- ischemic bowel
- multi organ system failure
ASA V obstetrics
- uterine rupture
ASA VI
Brain dead whose organs are being harvested for donation
Preoperative fasting - 8 hrs or more
Fried foods , fatty foods, meat, normal meal essentially
Preoperative fasting - 6 hrs
- non human milk
- infant formula
- light meals : toast and clear liquids ( water coffee black tea juice without pulp)
Preoperative fasting - 4 hrs
- breast milt
Preoperative fasting - 2 hrs
- clear liquids : black tea, black coffee, water , fruit juices without pulp, carbonated beverages
Components of anesthesia informed consent
Disclosure of information that a “reasonable person” would want in order to make a decision
Routine anesthetic
- pts medical condition. - procedures that will be performed. - risks
- consequences of care. - post op pain management : including options
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