preop evaluation (Mod 5)

Question 1

Know the American Society of Anesthesiologist physical status system (ASA PT) table

Answer 1

Adding E denotes an emergency

Question 2

have to be able to classify MET score, but don’t have to calculate it (slide 16)

Answer 2

Question 3

What is the purpose of the pre operative assessment?

Answer 3

To identify medical conditions that may adversely affected by the administration of anesthetic meds

Question 4

What part of the med history especially noted from a patient history?

Answer 4

symptoms and diseases related to cardiovascular, respiratory, and neuromuscular systems bc they directly influence the anesthetic

Question 5

What is Functional Capacity?

Answer 5

A predictor of post op cardiopulmonary or neurocognitive complications

Question 6

What is defined as a poor exercise tolerance?

Answer 6

</= 4 METS

Question 7

What is exercise capacity measured by?

Answer 7

Metabolic equivalents (MET)

• 1 MET = Consumption of 3.5 ml oxygen/kg/min of body weight

Question 8

How much is 1 MET equivalent to?

Answer 8

1 met = consumption of 3.5 ml oxygen/kg/min of body weight

Question 9

American Society of Anesthesiologists Physical Status (ASA PS) 1?

Answer 9

A fit and healthy patient (healthy, nonsmoking, exercise daily)

Question 10

American Society of Anesthesiologists Physical Status (ASA PS) 2?

Answer 10

A pt with mild systemic illness

• Mild disease without substantive functional limitations
• Current smoker, obesity, well controlled DM/HTN, mild lung disease, milkd lung disease

Question 11

American Society of Anesthesiologists Physical Status (ASA PS) 3

Answer 11

A pt with severe systemic disease, substantive functional limitations.

• one or more moderate to severe diseases
• i.e uncontrolled HTN, DM with vascular issues, pervious MI, COPD, Reduced EF

Question 12

American Society of Anesthesiologists Physical Status (ASA PS) 4

Answer 12

A pt with severe, systemic disease that is a constant threat to life

• CHF, Renal or hepatic failure, unstable angina

Question 13

American Society of Anesthesiologists Physical Status (ASA PS) 5

Answer 13

Moribund pt who is expected to die without surgery

• Ruptured AAA, PTE, Increased ICP, multi organ failure

Question 14

American Society of Anesthesiologists Physical Status (ASA PS) 6

Answer 14

Brain dead

Question 15

What is a good predicator of post op cardiopulmonary or neurocognitive complications?

Answer 15

Functional capacity (or incapacity)

Question 16

Which patients are most at risk throughout the perioperative period?

Answer 16

Those who had a recent MI and those with unstable angina

• Any Coronary Artery Disease (CAD) really

Question 17

Levels of Canadian Cardiovascular Society (CCS) Classification of Angina?

Answer 17

4, with decreasing level of activity with risk of causing severity

Question 18

CCS Functional Classification of Angina: Class 1?

Answer 18

Question 19

CCS Functional Classification of Angina: Class 2?

Answer 19

Question 20

CCS Functional Classification of Angina: Class 3?

Answer 20

Question 21

CCS Functional Classification of Angina: Class 4?

Answer 21

Question 22

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification?

Answer 22

4 classes that assess discomfort with physical activities that shows general signs of SOB and fatigue that would point towards CHF

Question 23

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 1

Answer 23

Question 24

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 2

Answer 24

Question 25

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 3

Answer 25

Question 26

The New York Heart Association Functional Classification of Heart Failure (NYHA) classification: 4

Answer 26

Question 27

what would increase the risk of adverse affect for surgery from the respiratory system side?

• Reword

Answer 27

• severe systemic infection or Pneumonia
• Upper resp tract infections or hyperactive airways may require several weeks to normalize before assessment

Question 28

What affect does smoking have on the respiratory system

Answer 28

• Increases risk of hypertension, tension, and PVD
• Decreases clearance of pulmonary secretions
• promotes bronchitis and exacerbates asthma…leading to development of COPD
• Increases risk of hypoxemia and impairs wound healing and the immune response

Question 29

What would improve the outcome for smokers periopertvly?

Answer 29

• Quantify smoking history (pack years)
• Initiation cessation program 4-8 weeks prior to surgery
• At the min, cease smoking for a min of 12-24 hrs prior to help reduce delirious effects of smoking

Question 30

What perioperative respiratory complications are COPD pts most at risk of

Answer 30

• Respiratory depression
• Atelectasis
• Retained secretions
• Pneumonia
• Respiratory insufficiency or failure

Question 31

Preoperative care of COPD patients?

Answer 31

• Smoking cessation
• Avoidance of bronchospasm via preop bronchodilation via SABAs (also for asthmatics)
• Treatment of AECOPD (antibiotics)

Question 32

What is typically performed prior to extensive surgery and why?

Answer 32

Spirometers and ABGs

• Resp function deteriotates following upper abdominal or thoracic surgery
• Lung detox ration will increase the risk of post op resp complications

Question 33

Assessment of patients at risk for CHF?

Answer 33

Inquire s&s of fatigue:

• syncope
• dyspnea
• orthopnea
• paroxysmal nocturnal dyspnea (PND)
• and cough

And refer to the NYHA classifcation of heart failure