Surgery: Pre-op

Question 1

important pre-op history: allergies

Answer 1

Prior anesthesia experience and responses to anesthetics

Question 2

what patients need Chest Xray before any surgery ?

Answer 2

All patients older than 60 and/or significant pulmonary or cardiac history
*Abnormalities on CXR must be worked up prior to surgery.

Question 3

who needs pre-op EKG? what does an abnormal result need?

Answer 3

if age > 40 or other major comorbidities

*Abnormal EKG warrants a Cardiology consult or stress test.- BEFORE surgery

Question 4

a “silent” MI, detected on pre-op EKG, are most common in what two pt populations

Answer 4

elderly and diabetics.

Question 5

two “blood type” tests for pre-op: type and cross vs type and screen

Answer 5

Type and screen: for routine, unlikely needing transfusion surgery
Type and Cross: specify # units that may be required during surgery (at least 2 units)

Question 6

what lab value is ALWAYS a trigger for further evaluation and/or possible postponement of surgery? (KNOW)

Answer 6

low platelet count

Question 7

what two pieces of info does BMP/CMP provide for pre-op?

Answer 7

Provides baseline electrolyte levels ( K+ and Na+ ) as well as BUN/Cr to determine renal function

Question 8

what info does PT/INR provide for pre-op? PTT? KNOW

Answer 8

necessary if on warfarin or liver dysfunction; heparin

Question 9

why do we do a pre-op UA?

Answer 9

Can identify UTI/hematuria
Any urinary infection should be treated prior to surgery, especially if a prosthesis of any kind is going to be implanted (EVEN ASYMPTOMATIC)

Question 10

what is “detskys modified cardiac risk assessment”?

Answer 10

assigns points for certain pt history
-chances for MI for those with cardiac issues if they get operation
Class I 0-15 (low risk ) to Class III 31 +(high risk )

Question 11

what are the most common cause of post-operative morbidity? what surgery increases these chances? KNOW

Answer 11

Post-operative pulmonary complications

*anytime there is surgery around muscles/structures around the lungs (associated with diminished residual capacity)

Question 12

Smokers are at a ___to ___times greater risk for pulmonary complications.

Answer 12

2-6 times greater

Question 13

American Society of Anesthesiologists Physical Status Classification
KNOW

Answer 13

Class 1: Healthy patient, no medical problems.
Class 2: Mild systemic disease
Class 3: Severe systemic disease, but not incapacitating
Class 4: Severe systemic disease that is a constant threat to life
Class 5: Moribund, not expected to live 24 hours regardless of
operation

Question 14

assessment of coagulation status: PT/INR (KNOW)

Answer 14

measures the extrinsic pathway of coagulation

- determines the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status.

Question 15

normal INR range

Answer 15

INR is 0.8–1.2

Question 16

assessment of coagulation status: PTT (KNOW)

Answer 16

indicator measuring the efficacy of the intrinsic

-determines treatment effects with heparin.

Question 17

normal Ptt range

Answer 17

35-45

Question 18

4 reasons renal function needs to be tested for preop?

Answer 18

1. Baseline renal function tests ( BUN/Cr/GFR )
2. Avoid hypotension
3. Adjust nephrotoxic drugs based upon renal function
4. Attention to electrolyte status: K+, Mg+, Phos.
   5) . modification of hemodialysis

Question 19

three reasons liver dysfunction needs to be evaluated for preop?

Answer 19

1) . Platelet dysfunction
2) . Medication metabolism can be effected
3) . Vitamin and mineral deficience
4) . decrease in sodium excretion

Question 20

3 reasons DM needs to be evaluated for preop?

Answer 20

1. Increased risk of hyper/hypoglycemia and infection (if uncontrolled)
2. obtain euglycemia
3. DM pts may have 2-4 times the risk of CV mortality

Question 21

patients with previously uncontrolled DM with oral agents may require what prior to surgery?

Answer 21

insulin

Question 22

DM NPO patients should do what to their dose of insulin the morning of surgery?

Answer 22

NPO patients should reduce their morning dose of insulin to one-half of the usual dose

Question 23

5 preop orders (KNOW)

Answer 23

1. NPO past Midnight : need 8 hours for reduction in aspiration risk
2. Antibiotics on call to OR: Should be given within 30 minutes of the incision
3. Medications: Can they take AM meds with sip of water?
4. Void on call to OR: Catheter usually placed once in OR suite
5. Hospitalization or outpatient procedure

Question 24

5 ways you can prevent infection prior to surgery? (KNOW)

Answer 24

1. Use of broad spectrum cephalosporin (cover for Staph- most common infection)
2. Removal of hair
3. Eradicate dead spaces - suture them up
4. Operative time ideally < 2 hrs. (above this, chances of infection increase)
5. Closed system drainage away from the incision site

Question 25

two tx used to prevent DVT/PE post surgery?

Answer 25

1. lovenox (LMW heparin) or heparin

2. EARLY AMBULATION

Question 26

what is virchow’s triad?

Answer 26

increases risk of Thrombosis:

1) vascular injury
2) . hemostasis
3) . hypercoagulability

Question 27

what test to determine adequacy of nutrition prior to procedure?

Answer 27

Prealbumin

Question 28

what 3 complications can poor nutrition/malnutrition cause for surgery?

Answer 28

Causes poor wound healing, poor bone growth and overall increases chances of post-operative complications.

Question 29

Much higher risk of what two things if MI within previous 30 days?

Answer 29

morbidity and mortality

Question 30

preop glucose control should be in what range?

Answer 30

100-150

Question 31

things that need to be investigated prior to surgery (6) KNOW

Answer 31

1) . abnormal labs: CBC, renal or liver dysfunction, LOW platelet count
2) . DM (uncontrolled)
3) . abnormal UA/UTI
4) . pneumonia/ lung problems
5) . EKG abnormalities
6) . CXR abnormalities

Question 32

how do you properly consent a patient? KNOW

Answer 32

CONVERSATION