Preoperative Evaluation Flashcards
(15 cards)
What is the #1 limiting factor prior to surgery?
Hx of Cardiovascular disease
What tool is used to estimate a patient’s risk of perioperative cardiac complications?
RCRI index
What risk factors are used for the RCRI?
Hx of ischemic heart disease
Hx of CHF
Hx of cerebrovascular disease: Stroke or TIA
Hx of DM requiring insulin
CKD: Cr >2
Suprainguinal, Intraperitoneal or intrathoracic surgery
What RCRI score indicates an increased risk for cardiac events?
> 2
What is the next best step for patients with an RCRI score of 2 or more?
Perioperative beta-blockade to reduce cardiac mortality
What is used to assess the fitness of patients before Surgery?
ASA system
What is the ASA system scored on?
1 point for each of the following
-Healthy
-Mild systemic disease
-severe systemic disease
-severe systemic disease that is a constant life threat
-moribund person not expected to survive without surgery
-declared brain dead: surgery to harvest organs
What ASA Score requires further perioperative assessment?
> 3
What CVD assessment is needed for a patient <35 with no hx of cardiac disease?
EKG
If a patient has a hx of CVD what tests are required?
EKG
Stress test: evaluate ischemic coronary lesions
Echo: only if a hx of structural disease to evaluate ejection fraction
What BP reduced perioperative cardiac complications?
<140/90
What patients require PFT prior to surgery?
Patients with known lung disease or smoking history to evaluate Vital capacities
How long before surgery should patients quit smoking?
6-8 weeks
What is used to help patients quit smoking prior to surgery?
Nicotine replacement therapy
Bupropion or Varenicline
How can you ensure adequate kidney function in patients with renal disease?
Fluids before and during surgery
If on dialysis: dialyze 24 hours prior to surgery
