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Assessment > Preoperative Evaluation > Flashcards

Preoperative Evaluation Flashcards

1
Q

Chest Radiography

A
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2
Q

pre-op eval for surgeons/hospital

A

—Decreases cost of perioperative care

—Improves efficiency

—Decreases cancellations/delays

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3
Q

—Regional anesthesia

A
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4
Q

Medications-On hold day of surgery

ARB’s

A
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5
Q

—Coagulation

A

all pregnant ladies get platelet

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6
Q

Test Utility

A
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7
Q

Minor predictors

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8
Q

Enhanced Recovery After Surgery “ERAS”

A
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9
Q

—Blood sugar

A
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10
Q

Surgical Care Improvement Project- ABT

A
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11
Q

—Pregnancy Tests

A
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12
Q

Steroids and HPA suppression

A
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13
Q

special pointers

A

—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

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14
Q

Treatment of PONV

A
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15
Q

Medications-On hold varying amounts

A
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16
Q

Medications-On hold day of surgery

ACE inhibitore

A
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17
Q

Basic Preoperative Standards- legal

A

—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
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18
Q

—Liver enzymes

A
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19
Q

Medications-On hold day of surgery

A
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20
Q

Examples of ERAS protocol

A
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21
Q

Anti-Hypertensive Medications- Continue

mixed alpha beta blockers

A
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22
Q

—Electrolytes

A
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23
Q

Treatment based guide

A
24
Q

—Antisialogogue effects

A
25
Q

—General Anesthesia

A
26
Q

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

A

—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

27
Q

What should you accomplish?

A

—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

28
Q

—Creatinine

A
29
Q

Surgical Care Improvement Project- study

A
30
Q

Preoperative Lab Work

A

not super helpful

31
Q

Revised Cardiac Risk Index

A

—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%

32
Q

Assessment in an Emergency

A

—A: allergies

—M: medications

—P: past medical history

—L: last meal eaten

E: events leading

33
Q

Disease-based guide

A
34
Q

Intermediate predictors

A
35
Q

—CBC

A
36
Q

Functional Capacity (>4METs)

A
37
Q

—Pain control

A
38
Q

Other- On hold varying amounts

A
39
Q

Pulmonary Risk Indicators

A
40
Q

Preop Fasting Guidelines

A
41
Q

ERAS

A
42
Q

Focused Preop Exam

A

—Airway

—Cardiovascular

—Pulmonary

—Depending on type of procedure

  • Neuro….focal deficits
  • Vascular….invasive monitors
  • Regional site….infection/distortion of anatomy
43
Q

Patient-Related Risks: ACC/AHA

A

—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

44
Q

ECG algorithm

A
45
Q

—Psychological preparation

A
46
Q

Surgical Risks

A
47
Q

Anti-Hypertensive Medications- Continue

non-selective beta blockers

A
48
Q

pre-op eval For the anesthesia provider

A

—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

49
Q

Anti-Hypertensive Medications- Continue

cardioselective beta blockers

A
50
Q

—Aspiration precautions

A
51
Q

—PONV

A

nitrous doesn’t cause n/v if <50%

52
Q

—meds to continue

A
53
Q
A
54
Q

—Conscious sedation

A
55
Q

Pre-op eval For the patient

A

—Reduces anxiety

—Provides education

—Discuss medications

—Reduces postoperative morbidity

—Answers questions

56
Q

Major Predictors

A
57
Q

—UA

A

Assessment (8 decks)

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