5 cardinal functions of anesthesia
- analgesia
- amnesia
- hypnosis
- muscle relaxation
- blunting autonomic reflexes
surgical urgency: emergent
- immediate threat to life or limb
- intervention needed <2 hours from presentation
surgical urgency: urgent
- threat to life or limb w/o intervention, but still time for pre-op eval
surgical urgency: time sensitive
- can be delayed up to 3 months to allow for pre-op eval, management plan
surgical urgency: elective
- no time frame
- full eval, management plan made
low risk MACE
- CV intact
- MACE risk <1%
functional capacity in metabolic equivalents
patient should be able to meet 4 METs: activity that expends 4x energy used by body at rest w/ no SOB, limitation s
- stairs, household chores, running short distances
high risk MACE
> 1%
mallampati classification: I
- can see soft palate, uvula, fauces, pillars
- no difficulty intubating
mallampati classification: II
- can see soft palate, uvula, fauces
- no difficulty intubating
mallampati classification: III
- can see soft palate, base of uvula
- moderate difficulty intubating
mallampati classification: IV
- can only see hard palate
- severe difficulty intubating
ASA physical status: I
normal, healthy patient
ASA physical status: II
mild, systemic disease w/ no functional limitation
- medicated/controlled
ASA physical status: III
severe systemic illness, functional limitation
ASA physical status: IV
severe systemic disease that is a constant threat to life
ASA physical status: V
moribund pt, not expected to live w/o surgery
ASA physical status: VI
brain dead
5 principles of outpatient anesthesia
- active, intentional pre-op planning
- opioid-sparing pain control
- regional or combined anesthesia approach
- TIVA over inhaled
- proactive prevention of PONV
SCIP measure 1
pre-op prophylactic antibiotics should be administered 1 hour prior to incision
(2 hours if vancomycin or fluoroquinolones)
SCIP measure 2
prophylactic antibiotic selection: usually 1st, 2nd gen cephalosporin or vancomycin
SCIP measure 3
prophylactic antibiotics should be discontinued within 24 hours after surgical end time
SCIP measure 6
appropriate hair removal from surgical sites: electric shaver
SCIP card 2
pts on beta blockers should receive them before arrival or during perioperative period
