Preoperative Evaluation

Question 1

Chest Radiography

Answer 1

Question 2

pre-op eval for surgeons/hospital

Answer 2

—Decreases cost of perioperative care

—Improves efficiency

—Decreases cancellations/delays

Question 3

—Regional anesthesia

Answer 3

Question 4

Medications-On hold day of surgery

ARB’s

Answer 4

Question 5

—Coagulation

Answer 5

all pregnant ladies get platelet

Question 6

Test Utility

Answer 6

Question 7

Minor predictors

Answer 7

Question 8

Enhanced Recovery After Surgery “ERAS”

Answer 8

Question 9

—Blood sugar

Answer 9

Question 10

Surgical Care Improvement Project- ABT

Answer 10

Question 11

—Pregnancy Tests

Answer 11

Question 12

Steroids and HPA suppression

Answer 12

Question 13

special pointers

Answer 13

—Airway….look carefully

—Allergies…are they really?

—Weight… pounds/2 and -10% =kg

—PMH….explore when, where, what

—Look at lab, EKG, CXR, etc…..

—Think of what YOU want to know that is missing

Question 14

Treatment of PONV

Answer 14

Question 15

Medications-On hold varying amounts

Answer 15

Question 16

Medications-On hold day of surgery

ACE inhibitore

Answer 16

Question 17

Basic Preoperative Standards- legal

Answer 17

—AANA

-Standard I: Perform and document a thorough pre-anesthesia assessment and evaluation

—ASA

• Interview patient to review medical, anesthesia, and medication history
• Appropriate physical examination
• Review diagnostic data
• Assignment of ASA physical status score

Question 18

—Liver enzymes

Answer 18

Question 19

Medications-On hold day of surgery

Answer 19

Question 20

Examples of ERAS protocol

Answer 20

Question 21

Anti-Hypertensive Medications- Continue

mixed alpha beta blockers

Answer 21

Question 22

—Electrolytes

Answer 22

Question 23

Treatment based guide

Answer 23

Question 24

—Antisialogogue effects

Answer 24

Question 25

—General Anesthesia

Answer 25

Question 26

The old vs the new- need to be seen few days before- not to memorize

Answer 26

—Admission to hospital within last 2 months —History of CAD/MI/poorly controlled HTN/CHF —Acute exacerbation of asthma/COPD —History of airway tumor/obstruction —Type I diabetes —Adrenal disorders —Active thyroid disease History of seizure disorder —History of muscular disorders —TMJ disorders/Kyphosis/scoliosis causing functional compromise —Hepatobiliary compromise —Immune compromised —Massive obesity

Question 27

What should you accomplish?

Answer 27

—History —Physical Exam —Lab/ECG/CXR —Cardiac risk assessment —Discussion of types of anesthesia —Discussion of risks/benefits/alternatives —Discussion of invasive monitors/blocks —Instructions regarding medications, fasting

Question 28

—Creatinine

Answer 28

Question 29

Surgical Care Improvement Project- study

Answer 29

Question 30

Preoperative Lab Work

Answer 30

not super helpful

Question 31

Revised Cardiac Risk Index

Answer 31

—Originally published 1977 —Revised 1999 based on 4,315 patients… —Prediction tool —Associates preoperative variables and procedure -Age, type of surgery, comorbid diagnoses, lab data —Cerebrovascular disease —Congestive heart failure —Creatinine level \>2.0mg/dL —Insulin dependent diabetes mellitus —Ischemic cardiac disease —Intermediate/High risk surgery - Supra-inguinal vascular - Intrathoracic - Intraabdominal 0=0.4%; 1=0.9%; 2=6.6%; 3 or \> 11%

Question 32

Assessment in an Emergency

Answer 32

—A: allergies —M: medications —P: past medical history —L: last meal eaten E: events leading

Question 33

Disease-based guide

Answer 33

Question 34

Intermediate predictors

Answer 34

Question 35

—CBC

Answer 35

Question 36

Functional Capacity (\>4METs)

Answer 36

Question 37

—Pain control

Answer 37

Question 38

Other- On hold varying amounts

Answer 38

Question 39

Pulmonary Risk Indicators

Answer 39

Question 40

Preop Fasting Guidelines

Answer 40

Question 41

ERAS

Answer 41

Question 42

Focused Preop Exam

Answer 42

—Airway —Cardiovascular —Pulmonary —Depending on type of procedure - Neuro….focal deficits - Vascular….invasive monitors - Regional site….infection/distortion of anatomy

Question 43

Patient-Related Risks: ACC/AHA

Answer 43

—Major Predictors -MI\< 6wks old, USA, Decompensated CHF, Severe valvular dz —Intermediate Predictors -Mild angina, MI \> 6wks old, compensated CHF, DM —Minor Predictors -Advanced age, non-sinus rhythm, abnormal EKG, Low METS

Question 44

ECG algorithm

Answer 44

Question 45

—Psychological preparation

Answer 45

Question 46

Surgical Risks

Answer 46

Question 47

Anti-Hypertensive Medications- Continue non-selective beta blockers

Answer 47

Question 48

pre-op eval For the anesthesia provider

Answer 48

—Learn of medical conditions —Devise an anesthetic plan - Intraoperative - Postoperative —Time for consultants —DNR- 3 options 1) tx hypotension and stuff 2) resend completely 3) doc uses judgement

Question 49

Anti-Hypertensive Medications- Continue cardioselective beta blockers

Answer 49

Question 50

—Aspiration precautions

Answer 50

Question 51

—PONV

Answer 51

nitrous doesn't cause n/v if \<50%

Question 52

—meds to continue

Answer 52

Question 54

—Conscious sedation

Answer 54

Question 55

Pre-op eval For the patient

Answer 55

—Reduces anxiety —Provides education —Discuss medications —Reduces postoperative morbidity —Answers questions

Question 56

Major Predictors

Answer 56

Question 57

—UA

Answer 57