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N928 - Basics of Anesthesia > Preoperative Interview > Flashcards

Preoperative Interview Flashcards

1
Q

purpose of preop interview

A
  • evaluate patient’s current physical status

- optimize patient for surgery

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2
Q

goals of preop interview

A
  • obtain med/surgical history
  • determine need for preop testing/consults
  • form and deliver anesthetic plan
  • minimize morbidity and mortality
  • optimize patient safety/satisfaction
  • prevent surgical cancellations/delays
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3
Q

AANA Standard 1

A

Patient’s Rights

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4
Q

AANA Standard 2

A

Preanesthesia patient assessment and evaluation

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5
Q

AANA Standard 3

A

Plan for anesthesia care

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6
Q

AANA Standard 4

A

Informed consent for anesthesia care and related services

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7
Q

AANA Standard 5

A

documenation

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8
Q

AANA Standard 6

A

equipment

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9
Q

components of anesthesia care documentation

A
  • name and MRN
  • name(s) of anesthesia professional(s) involved in care
  • immediate preanesthesia assessment and evaluation
  • anesthesia safety checks
  • monitoring of patient
  • airway techniques
  • anesthesia meds (+ 5 rights)
  • technique(s) used and positioning
  • name + amounts of IV fluids
  • IV lines
  • complications, adverse reactions, or problems
  • status of patient post-anesthesia
  • document in timely and legible manner
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10
Q

Previous Pre-op anesthesia

A
  • hospital admission prior to DOS
  • preop interview by anesthesia provider
  • many labs, x-rays, bowel prep, etc.
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11
Q

current pre-op anesthesia

A
  • preoperative anesthesia interview clinics
  • prior to actual DOS interview (phone or clinic)
  • typically w/in 1-2 weeks of scheduled DOS
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12
Q

PAT clinic interviewers

A
  • RN
  • PA
  • NP
  • problem - they do not necessarily have all the in depth anesthesia knowledge to get all the information we need to provide safe anesthesia care
  • why it is our job/obligation to verify all information on the DOS
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13
Q

essential components of anesthesia interview

A
  • BMI (height and weight)
  • allergies
  • NPO status
  • medications
  • surgical history
  • previous anesthetics/complications
  • medical history
  • pregnancy
  • ROS
  • Airway assessment
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14
Q

BMI Calculation

A

units = kg/m2

[weight (pounds) / height (inches)2] x 703

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15
Q

allergies

A
  • allergen
  • type of reaction
  • differentiate between s/e and true allergic reactions
  • throat/tongue swelling, difficulty breathing = anaphylaxis
  • ask about –> drugs, dyes, contrast, latex, food, tape
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16
Q

anesthetic/surgical history

A
  • type of surgery
  • type of anesthesia
  • date
  • complications (PONV, MH, difficult intubation, recall, prolonged wake-up, unplanned post-op intubation)
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17
Q

past difficult intubation

A
  • usually have letter/card from previous anesthesia provider or medic alert
  • how to ask patient - sore throat for more than 2 days after surgery
  • significant weight gain since last surgery? could make them a higher risk for difficult intubation
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18
Q

MH history

A
  • MH = inherited myopathy (dysfunction of ryanadine receptor, cannot sequester calcium, sustained contraction, HEAT released, hypermetabolic state)
  • inherited myopathy (autosomal dominant)
  • triggered by volatile anesthetics and depolarizing NMBDs (succinylcholine)
  • ask about patient or fam hx of MH + outcome
  • ask about genetic testing
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19
Q

MH OR preparation

A
  • remove vaporizers
  • change CO2 absorbent
  • change entire circuit
  • flush machine with O2 flush
  • know where emergency MH cart is
  • try to make them the first case of the day
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20
Q

pertinent records to obtain

A
  • associated with surgical or anesthetic complications
  • consults
  • special tests
  • any records providing insight into patient’s status and/or complications
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21
Q

what does NPO stand for

A
  • nil per os

- nothing by mouth

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22
Q

purpose of NPO guidelines

A
  • reduce risk for aspiration

- educate patient on aspiration and importance of NPO guidelines

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23
Q

aspiration

A

accidental inhalation of gastric contents into lungs –> chemical burn of tracheobronchial tree and pulmonary parenchyma –> intense parenchymal inflammatory reaction

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24
Q

ideal GI environment for surgery

A
  • gastric contents less than 25 mL

- pH > 2.5

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25
patients with delayed gastric emptying times
- may require individualized guidelines - DM - recent injuries - obesity - abdominal complaints - GERD - pregnancy or recent delivery - ascites
26
how do we manage increased aspiration risk
- neutralized stomach acid - perform RSI (with ETT) - induce with HOB up - potential for NGT
27
2 hours
clear liquids (water, black coffee, tea, pulp-free juice, carbonated beverages)
28
4 hours
breast milk
29
6 hours
formula, cows milk, tea/coffee with milk, full liquids, light meal (low or nonfat), gum, sweets (hard candy)
30
8 hours
full meal, fried/fatty foods
31
Selleck's Maneuver
- attempt to protect against aspiration - straight downward force on cricoid cartilage - compress the esophageal lumen between cricoid cartilage and cervical spine - amount of force = 30-40 Newtons (or 3-4kg, 6.6-8.8 lbs)
32
Selleck's Maneuver contraindications
- neck injury - esophageal tear/rupture - if pt is actively vomiting - can build up pressure and rupture esophagus
33
Physical exam baseline components
- heart/lung sounds - breathing pattern - bruising/scarring - peripheral pulses - edema - VS - mental status
34
airway assessments
- have many different tools we can use to determine whether or not patient will be a difficult intubation - subjective assessments - dependent on provider as well as patient participation/position
35
Mallampati Class
- ID hard palate, soft palate, tonsils/faucial pillars, and uvula - rating I-IV - instruct patient - look at you with chin elevated, mouth open wide, and tongue sticking out - MP class III or IV means greater chance of difficult airway
36
MP 0
visualize faucial pillars, hard palate, soft palate, uvula and epiglottis
37
MP 1
visualize faucial pillars, hard palate, soft palate, and uvula
38
MP 2
visualize faucial pillars, soft palate, and partial uvula
39
MP 3
visualize soft palate and base of uvula
40
MP 4
visualize hard palate only
41
mouth opening/inter-incisor gap
-want patient to be able to open mouth at least 3 fingerbreadths
42
temporomandibular joint (TMJ)
-maxilla and mandible meet (upper and lower jaw) -ball and socket joint used to chew, talk, yawn composed of muscles, tendons, bones
43
TMJ disorders
- limited mouth opening - teeth grinders - gum or fingernail chewers - stress - clench teeth - jaw trauma
44
thyromental distance/Patil's test
- assessment of mandibular space | - head fully extended from the mentum to the thyroid notch (upper edge of thyroid cartilage to chin)
45
short thyromental distance
- less space to displace tongue - visualization (intubation) may be difficult - anterior larynx - more acute angle - less space for the tongue to be compressed into by the laryngoscope blade
46
normal thyromental distance
3 fingerbreadths | >7 cm usually associated with easy intubation
47
short thyromental distance
<6 cm may predict difficult intubation
48
prayer sign
- indicative of degree of mobility of joints (subtle or overt joint contractures, decreased joint/cartilage mobility) - ask patient to place palms together - negative prayer sign - can stick palms together, no space - positive prayer sign - unable to stick palms flat together, could be indicative of difficult intubation (d/t potential for limited alanto-occipital joint movement)
49
decreased cervical mobility
-prevents proper positioning for intubation/prevents optimal view of glottic opening
50
assess cervical mobility
- ask patient to turn their head from side to side - touch their chin to their chest - point their chin to the ceiling - ask about numbness/tingling in upper extremities while performing cervical mobility
51
sniffing position
- optimal position for intubation | - aligning of axes
52
OPL
- axes we want to align for intubation - oral - pharyngeal - laryngeal
53
teeth/dentition
- assess teeth as good, fair or poor according to visible decay - any loose, cracked, chipped teeth? --> document location - note any dentures, partials, caps, crowns
54
neck circumference
- large neck circumference = >45 cm - combination of this with large BMI could mean a difficult intubation - increased adipose tissue is forced down by gravity when patient supine and has the potential to occlude airway
55
STOP BANG
- assessment tool for OSA - Snore - Tired - Observed apneic/not breathing - Pressure (high BP) - BMI >35kg/m2 - Age older than 50 years - Neck circumference > 40cm - Gender (males more)
56
facial hair
- difficult mask seal | - disguise potential airway problems - retrognathia or short thyromental distance
57
possibility of pregnancy
- in biologically female patients - LMP? - sexually active? - facility policy - may be required to obtain pregnancy test prior to surgery - HCG - human chorionicgonadotropin
58
medications
- current medications (OTC, prescription, vitamins, herbal supplements, home remedies) - which to take/hold DOS (pre op clinic) - is patient reliable to report meds
59
meds to take before surgery
- beta-blockers - GERD meds - calcium channel blockers - bronchodilators - antiarrhythmics - steroids - diuretics (if hx CHF) - antipsychotics - sz medications - thyroid meds
60
meds to hold before surgery
- oral hypoglycemics - ACE inhibitors - A2RBs - diuretics (if no hx CHF) - herbal supplements - anticoagulants (on case by case basis per surgeon)
61
HTN (CV)
- duration of disease - exercise tolerance - recent EKG - medication regimen (antihypertensives, compliance, well-controlled)
62
Angina/CAD/MI (CV)
- exercise tolerance, symptoms, precipitating factors - last chest pain, date of MI, methods of relief - interventions if any - EKG, ECHO, Cath, most recent cardiologist visit, cardiac clearance
63
recent MI
6 months
64
newly diagnosed CHF or CHF + exacerbation requiring hospitalization in last 6 months
6 months
65
aortic stenosis
12 months
66
valvular disease (CV)
- do they have it? AS, AR, MS, MR, MVP? - symptomatic, chest pain, SOB? - prophylactic abx for dental work? - recent and/or comparative ECG, ECHO, cardiology note/consult/clearance
67
syncope (CV)
- faint or pass out - ask about cause - last episode - treatment
68
arrhythmias (CV)
- type - intermittent or continuous - interventions - current medical management - anticoagulants or antiarrhythmics - review past/current ECG, cardiology notes - heart block patients may have pacemaker/AICD - may need device rep present (manufacturer's card will have information); some places have trained device teams so no need for rep
69
CHF (CV)
- current disease status - recent weight gain (get weight DOS) - peripheral edema/anasarca - dyspnea or difficultly breathing while lying flat - recent exacerbation requiring hospitalization - recent changes in medical management - current EKG and recent ECHO with documented EF - take diuretics DOS
70
asthma (resp)
- frequency of attacks - trigger - date of last attack - hospitalizations, intubations, or ER - treatment regiment (inhaler/neb type, how often, current or past oral steroids, home oxygen)
71
bronchitis/pneumonia (resp)
- date of last event - med regimen - pulmonary reports (CXR, PFT, ABG)
72
URI (resp)
-symptoms -amount/color drainage -treatment (abx?) peds patients - change in activity level, appetite, fluid intake
73
emphysema (resp)
- oxygen at home - meds (inhaler, neb, corticosteroids) - pulm reports (PFTs, CXR, ABG)
74
TB (resp)
- active TB or positive PPD - active or latent - symptoms - persistent cough, chest pain, fatigue, loss of appetite, weight loss, fever, chills, night sweats - new onset or worsening symptoms - isoniazid therapy? - CXR indicated if symptomatic
75
OSA (resp)
- CPAP or BiPAP (bring DOS) | - settings?
76
tobacco use (resp)
- packs per day (ask about vape, snuff, all tobacco products) - years of use - pack year = # years smoked x packs/day - former smoker ask same details
77
stroke (neuro)
- date of occurrence - CBF studies - carotid doppler - angiogram - residual deficits - hemiparesis, dysphagia, visual disturbance
78
HA (neuro)
- frequency - precipitating factors - what relieves pain - debilitating migraines - seen neurologist?
79
seizures (neuro)
- hx of seizures - type (grand mal, tonic clonic) - frequency - date of last activity - cause (ETOH, head injury, febrile) - med regimen - assess anticonvulsant blood level (want therapeutic bc don't want seizure during surgery) - take anticonvulsant DOS
80
neuropathy (neuro)
- ID potential unique positioning needs - site of neuropathy - type (numbness, tingling, pain, loss of sensation)
81
GERD (GI)
- aspiration concern - use and frequency of meds - associated past surgeries (Nissen, esophageal dilation) - factors and frequency of reflux - dysphagia or chocking - take GERD prescription meds DOS
82
hiatal hernia/bowel obstruction (GI)
-both at increased risk for aspiration
83
DM Type I or Type II (endocrine)
- insulin dependent - oral hypoglycemics - duration of disease - followed by endocrinologist - compliant with meds/BG checks - talk to endo/patient about how to dose - rule of thumb - HOLD oral hypoglycemics 24-48hrs + basal insulin will decrease night before and no short acting insulin in AM
84
hypothyroid disease (endocrine)
- weight gain since last surgery - cold intolerance (bair hugger) - fatigue - depression (prescription meds) - dry skin (careful with tape) - muscle cramp - assess goiter (potential encroachment on airway)
85
hyperthyroid disease (endocrine)
- weight loss - increased HR (may be on beta blocker) - heat sensitivity - nervousness - anxiety - may need benzos
86
RA (autoimmune)
- inflammation/chronic pain - hoarseness or dysphagia - steroid use - stridor - limited mouth opening - possible cervical spine instability - potential difficult airway d/t TMJ disease, decreased cervical spine mobility, or arytenoid joint mobility
87
MSK
- MSK d/o with implications r/t meds or positioning | - muscular dystrophies (NO succinylcholine)
88
hepatic
- hepatitis - type, date, tx - jaundice - origin - cirrhosis - tx - alcohol - amt, frequency, type - consider coagulation studies - PT/PTT, liver panel, ECG
89
renal
- renal failure (acute/chronic) - ESRD - dialysis schedule, date of last dialysis, lytes, CBC, PT/PTT, LFTs, ECG - dialysis (hemo or peritoneal)
90
social history
-alcohol -tobacco produces -recreational drugs type, frequency, amount, time of last use
91
heme/onc
- hx of anemia - coagulopathies - ITP/TTP/HUS - DVT - PE - anticoagulation - sickle cell - transfusions hx - bleeding tendency - cancer/malignancy
92
anesthetic plan components
- type of anesthesia (general, TIVA, regional) - airway devices (ETT, LMA) - type of induction (standard, RSI) - medications - monitoring modalities/special equipment (standard monitors, art line, central line, US, doppler, fluid warmer, bair hugger)
93
ASA 1
normal healthy patient
94
ASA 2
mild systemic disease
95
ASA 3
severe systemic disease
96
ASA 4
severe systemic disease that is a constant threat to life
97
ASA 5
moribund patient not expected to survive without surgery
98
ASA 6
declared brain dead; organ procurement
99
E classification
- emergency surgery; add to any of the ASA classifications - get consent if possible - anticipate equipment needs - med considerations - blood products - additional help
100
informed consent
- as a student NEVER GET CONSENT - discuss plan, alternatives, risks, potential complications with patient - address patient questions - obtain written consent (phone, verbal)

N928 - Basics of Anesthesia (17 decks)

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