What are the 5 Basic components to developing a good anesthesia plan?
- History and Physical
- Review co-existing diseases
- Review ASA Classification
- ASA monitoring standards
- Developing and Anesthetic plan
What are the 3 major things that we examine ourselves as anthesia providers. Meaning, we don’t just read the chart and take someone else’s word for it?
- Airway evaluation
- Respiratory system- recent cough, auscultate, etc
- Cardiovascular- listen to heart, feel pulses, etc.
What are the 4 major things we are looking for when we do a pre-op assessment?
- Previous anesthetic complications
- Medication History
- Difficult Airway
- Patient of family history of malignant hyperthermia
When reviewing a patient’s medication history it is important to ask about which 4 groups of medications that could complicate our anesthesia plan?
- MAOi’s
- Anticoagulants
- Supplements/ Herbals
- Substance abuse
What are the 11 components of the pre-op evaluation?
- Pt. history
- Daily medications
- Physical exam
- Lab testing/ diagnostics
- ASA physical status class
- Fasting status and aspiration risk
- Formulation of plan
- Discussion of plan
- Informed Consent
- Documentation
- Medical consultation if needed
A normal, healthy patient with no systemic disease would be an ASA class _____
1
A pt. with mild to moderate systemic disease, well controlled, with no functional limitation would be an ASA class_____
2
A patient with severe systemic disease that causes functional limitation would be an ASA class ______
3
A patient with severe systemic disease that is a constant threat to life would be an ASA ____
4
A moribund pt, not expected to survive with or without the surgical procedure would be an ASA class ____
5
A patient declared brain dead whose organs are being harvested for donation would be an ASA class _____
6
Any patient with an emergency surgery would have what additional ASA class?
E
When instructing patients on NPO status and number of hours they should remain NPO, it is important to balance what two things?
the risk factors of fasting vs. the risk factors of being NPO
What are the fasting guidelines for “healthy” patients?
- NO chewing gum or candy after midnight
- Clear liquids up to 2 hours before OR
- Breast milk up to 4 hours before OR
- Light meal, milk or formula up to 6 hours before OR
- Sip of water or liquid pre-med up to 1 hour before OR
The risk of aspiration increases when pH falls to ______ and stomach contents exceed _______mL.
pH- 2.5
volume 25 mL
When giving reglan IVP for your pt. at risk for aspiration, should you push it fast or slow?
Do not push reglan fast. It will cause major GI cramping.
What are the 5 components of the airway exam?
- Mallampati classification
- Thyromental/ hyoid-mental distance
- Cerival ROM
- Dentition
- Size and shape of mandible
Should you stick to your inital anesthesia plan?
Not necessarily. You should formulate your specific plan but then be prepared to adjust based on the patient’s physiological response
Name 4 ways you can monitor how well your patient is tolerating your anesthesia plan?
- Reassess VS
- Airways status
- Response to pre-procedure meds
- Make sure all anesthesia equipment, supplies, and medications are checked and immediately available in case the pt. needs a change in anesthetic plan
The anesthesia plan should take what 5 things about the patient into consideration?
- Demographics (age, gender)
- Past medical history
- Previous surgeries
- Past anesthesia complications
- Proposed surgical procedure and its impact on anesthesia delivery
