PreOp Eval/PostOp Comps

Question 1

Common post operative problems and complications

Answer 1

• Inadequate pain control
  Fever
• Pulm, CV, GI, renal/urinary, neuro, and bleeding complications
• Infection

Question 2

Post operative fever may indicate what?

Answer 2

Atelectasis
UTI
Wound infection
Pneumonia
Sepsis

low grade fever may be normal tissue trauma of surgery

Question 3

Physiological cause of most post-op CV and pulmonary complications

Answer 3

acidosis, hypoxemia, and/or hypercarbia

volume disorders

Question 4

Common GI complications post surgery

Answer 4

N/V - narcotics
Gastroparesis
GI bleed or stress ulcers
C. diff

Question 5

How is MET’S significant in pre-operative eval?

Answer 5

Measure of energy expenditure

1 MET = sitting watching tv
4 MET = going up 1 flight of stairs

anything less than 4 increases post-op risk; asses CV and pulm more closely

Question 6

What to ask for in history in pre-operative eval?

Answer 6

angina, prior MI
CHF
HTN
valvular d/o
rhythm d/o
Recent URI
Asthma/COPD
Renal impairment
prolonged bleeding, coagulopathies
h/o TIA or stroke
h/o anesthesia problems
smoke?
obese?

Question 7

effects of over-sedation during surgery

Answer 7

atelectasis

Question 8

Indications for antibiotic prophylaxis pre-surgery?

Answer 8

Valvular heart disease
Prosthetics (ex. total hip)
Certain procedures (ex. colon resection, knee arthroscopy)

Question 9

Prophylaxis for pulmonary embolism post-surgery?

Answer 9

Get patients out of bed and moving
Mini-heparin; Lovenox
Pneumatic sequential stockings; ted hose for those at risk (hip surgery, Virchow’s triad)

Question 10

Ulcer prophylaxis for ICU patients

Answer 10

PPI’s

H2 blockers/ antacid

Question 11

Why do a preoperative eval?

Answer 11

decrease incidence of operative or post complications

Question 12

Post-operative N/V (PONV) risk factors

Answer 12

female
young
motion sickness
nonsmoker
prior PONV

Question 13

Prophylaxis for post-operative N/V

Answer 13

5HT-3 inhibitors
Scopalamine
Dexatmethosone
Metoclopromide

Question 14

American Society of Anesthesiologists (ASA) classification of surgery patients

Answer 14

I: Normally healthy pt
II: Mild/controlled systemic dz
III: Non-incapacitating severe systemic dz
IV: incapacitating / threat to life systemic dz
V: Moribund pt not expected to survive 24 hrs w/ or w/o operation (basically dead)

• most facilities do not do class 3 or above due to high risk of complications

Question 15

Why listen for carotid bruit in pre-op eval?

Answer 15

assess stroke risk

Question 16

Treatment of malignant hyperthermia during surgery

Answer 16

IV Dantrium

Question 17

Reasons for hypoxia in preoperative state

Answer 17

Over sedation
Atelectasis (and eventually pneumonia)
Aspirate