ERAS

Question 1

persistent post-surgical pain incidence is >30% after what 4 operations? (A, T, M, IH)

Answer 1

amputations, thoracotomy, mastectomy, inguinal herniorrhaphy

Question 2

what is the Surgical Risk Calculator that estimates the chance of an unfavorable outcome? (NSQIP)

Answer 2

National Surgical Quality Improvement Program (NSQIP)

Question 3

clears up to how many hours before induction in pts at low risk of aspiration?

Answer 3

2 hours

Question 4

how many grams of preop CHO drink?

1. at HS
2. 2-3 hours pre-induction

Answer 4

1. 100 grams

2. 50 grams

Question 5

Preop CHO drink decreases what 4 things? (IR, H, F, PONV)

Answer 5

insulin resistance, hunger, fatigue, PONV

Question 6

Abx prophylaxis:

1. give how many hours before skin incision?
2. d/c how many hours post op?
3. d/c how many hours post op for cardiothoracic surgeries?

Answer 6

1. 1 hour
2. 24 hours
3. 48 hours

Question 7

timing of antithrombotics are critical for neuraxial blocks to avoid what? (EH)

Answer 7

epidural hematoma

Question 8

are minidose SQ heparin doses a contraindication to neuraxial block or epidural catheter removal?

Answer 8

no

Question 9

neuraxial blocks may be performed how many or more hours before heparin administration?

Answer 9

1 hour or more

Question 10

if postop LMWH used, epidural catheter should be removed how many hours prior to first dose?

Answer 10

2 hours

Question 11

if epidural catheter already present:

1. it should be removed at least how many hours after dose of LMWH?
2. subsequent LMWH dosing after catheter removal should not be for how many hours?

Answer 11

1. 10 hours

2. 2 hours

Question 12

neuraxial blocks blunt what 2 responses to surgery? (N, M)

Answer 12

neuroendocrine, metabolic

Question 13

laparoscopic surgeries decrease what 2 things compared to open surgeries? (SSI, LOS)

Answer 13

surgical site infections, length of stay

Question 14

epidural at what part of the spine is recommended for major abd and thoracic surgeries?

Answer 14

thoracic

Question 15

are lumbar epidurals recommended for abd surgeries?

Answer 15

no

Question 16

reasons to not use lumbar epidural for abd surgery:

1. may not provide adequate what for the abd incision? (A)
2. frequently causes what 2 things? (UR, LLS/MB)

Answer 16

1. analgesia

2. urinary retention, lower limb sensory/motor block

Question 17

for arthroplasty surgery of hips and knees, what 2 nerves are blocked with continuous peripheral nerve block? (F, S)

Answer 17

femoral, sciatic

Question 18

what 2 surgeries have an open incision? (HR, A)

Answer 18

1. hernia repair

2. arthroplasty

Question 19

thoracic epidural analgesia (TEA) is the sole regional technique for what 3 surgeries? (N, E, OA)

Answer 19

1. nephrectomy
2. esophageal
3. open aorta

Question 20

what are the 2 regional techniques for arthroplasty surgery? (CPNB, PI)

Answer 20

1. continuous peripheral nerve block

2. periarticular infiltration

Question 21

what are the 2 regional techniques for thoracic surgery? (TEA, ICB)

Answer 21

1. thoracic epidural analgesia

2. intercostal block

Question 22

what are the 3 regional techniques for hernia repair? (LI, INB, TAP)

Answer 22

1. local infiltration
2. ilioinguinal nerve block
3. transversus abdominis plane block

Question 23

what are the 4 regional techniques for colorectal resection? (TEA, WIWR, ILA, IVL)

Answer 23

1. thoracic epidural analgesia
2. wound infusion with ropivacaine
3. intraperitoneal LA
4. IV lidocaine

Question 24

Local anesthetic fast-track spinal anesthesia doses (mg, range):

1. bupivacaine
2. ropivacaine
3. lidocaine

Answer 24

1. 3-7 mg
2. 5-10 mg
3. 30-40 mg

Question 25

Local anesthetic fast-track spinal anesthesia doses (mcg, range): 1. sufentanil 2. fentanyl

Answer 25

1. 5-10 mcg | 2. 10-25 mcg

Question 26

what specific nerve is blocked for hernia repairs?

Answer 26

ilioinguinal nerve