Scientific Principles > Week 13 - Preop Evaluation > Flashcards

Week 13 - Preop Evaluation Flashcards

(70 cards)

Study These Flashcards
1
Q

According to ASA what should be done during the preanesthesia visit?

A
  • An interview with the pt or guardian to establish a medical, anesthesia and medication history
  • An appropriate physical examination
  • Indicated diagnostic testing
  • Review of diagnostic data (labs, EKG, tests, consultations)
  • Assignment of an ASA physical status score
  • A formulation and discussion of anesthesia plans with the patient or a responsible adult before obtaining informed consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the general definition of each ASA score?

A

ASA I = normal healthy patient

ASA II: patient with mild systemic disease (3040)

ASA IV: patient with severe systemic disease that is a constant threat to life

ASA V: moribund patient who is not expected to survive without the operation

ASA VI: declared brain dead patient whose organs are being removed for donor purposes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What should you look up in the chart before the preanesthesia visit?

A
  • Assess pt’s surgical diagnosis and surgical procedure
  • Weight and BMI
  • Problem list, health history
  • Review surgical clinic notes and any other pertinent notes
  • Review outside records
  • Allergies and current medications
  • Review labs and tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When should you order labs/tests?

A

Only if the result will impact the decision to proceed with the planned procedure or alter the care plans

-healthy patients of any age and patients with known, stable, chronic diseases undergoing low to intermediate risk procedures are unlikely to benefit from any routine test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the appropriate indications for preop testing?

A

When an abnormal result is suspected based on clinical risk factors and this result will:

  • establish a new diagnosis
  • direct further preoperative testing or consultation
  • inform preoperative medication use
  • alter intraoperative monitoring or management
  • influence choice of surgical approach or anesthetic technique
  • influence decision to postpone or cancel surgery
  • change postop disposition
  • establish periop risk profile for communication with other physicians and pt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What non-cardiac surgical procedures or interventions are considered LOW cardiac surgical risk?

A
  • Superficial surgery
  • Breast
  • Dental
  • Endocrine: thyroid
  • Eye
  • Reconstructive
  • Carotid asymptomatic (CEA or CAS)
  • Genecology: minor
  • Orthopedic: minor
  • Urological: minor (TURP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What non-cardiac surgical procedures or interventions are considered INTERMIEDIATE cardiac surgical risk?

A
  • Intraperitoneal: splenectomy, hiatal hernia repair, cholecystectomy
  • Carotid symptomatic (CEA or CAS)
  • Peripheral arterial angioplasty
  • Endovascular aneurysm repair
  • Head/Neck surgery
  • Neurological or orthopedic: major (hip/spine surgery)
  • Urological or Gynecological: major
  • Renal transplant
  • Intra-thoracic: non-major
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What non-cardiac surgical procedures or interventions are considered HIGH cardiac surgical risk?

A
  • Aortic and major vascular surgery
  • Open lower limb revascularization or amputation or thromboembolectomy
  • Duodeno-pancreatic surgery
  • Liver resection, bile duct surgery
  • Oesophagectomy
  • Repair or perforated bowel
  • Adrenal resection
  • Total cystectomy
  • Pneumonectomy
  • Pulmonary or liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What six criteria does the Revised Cardiac Risk Index incorporate?

A
  1. Presence of ischemic heart disease
  2. History of HF
  3. History of cerebrovascular disease
  4. DM treated with insulin
  5. Cr level of 2 mg/dL or higher
  6. Intrathoracic, supra-abdominal or supra-inguinal vascular procedures

*presence of 0, 1, 2, or 3 factors is associated with 0.5%, 1.3%, 4%, and 9% risk of MACE (major adverse cardiovascular events)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the purpose of assessing functional capacity?

A

The ability to achieve a moderate level of activity without symptoms, denoted by a MET score of 4 or more predicts a low risk of perioperative complications

  • METs 1 = eating, working at computer, dressing
  • METs 5 = climbing 1-2 flights of stairs, dancing, bicycling
  • METs 10 = swimming quickly, running or jogging briskly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When might preop consultation be considered?

A
  • Diagnosis, evaluation, and improvement of a new or poorly controlled condition
  • Creation of a clinical risk profile that the patient and perioperative team use to make management decisions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is it recommended to get an Albumin lab preop?

A

Anasarca

Liver disease

Malnutrition

Malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is it recommended to get a CBC preop?

A 
Alcohol abuse
Anemia
Dyspnea
Hepatic or renal disease
Malignancy
Malnutrition
Personal history of bleeding
Poor exercise tolerance
Recent chemo or radiation therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is it recommended to get Creatinine lab preop?

A

Renal disease

Poorly controlled DM

Injection of contrast dye during the procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is it recommended to get a Chest x-ray preop?

A
  • Active, acute, or chronic significant pulmonary symptoms such as cough or dyspnea
  • Abnormal unexplained physical findings on chest exam
  • Decompensated HF
  • Malignancy within the thorax
  • Radiation therapy to the chest, breasts, lungs, thorax

*extremes of age, smoking, stable COPD, stable cardiac disease, or resolved recent upper respiratory infection should not be considered unequivocal indications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is it recommended to get an ECG preop?

A
  • Alcohol abuse
  • Active cardiac condition (new or worsening chest pain or dyspnea, palpitations, tachycardia, irregular heart bear, unexplained bradycardia, undiagnosed murmur, decompensated HF)
  • ICD
  • OSA
  • Pacemaker
  • Pulmonary HTN
  • Radiation therapy to chest, breasts, lungs, thorax
  • Severe obesity
  • Syncope
  • Use of amiodarone or digoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is it recommended to get Electrolyte levels preop?

A
  • Alcohol abuse
  • CV, hepatic, renal, or thyroid disease (check potassium in ESRD)
  • DM
  • Malnutrition
  • Use of digoxin or diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is it recommended to get a Glucose level preop?

A

DM – glucose level determination on day of surgery

Severe obesity

Use of steroids

*maybe get a HgbA1c as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is it recommended to get LFT labs preop?

A
  • Alcohol abuse
  • Hepatic disease
  • Recent hepatitis exposure
  • Undiagnosed bleeding disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is it recommended to get a Platelet count preop?

A
  • Alcohol abuse
  • Hepatic disease
  • Bleeding disorder (person or family history)
  • Hematologic malignancy
  • Recent chemo or radiation therapy
  • Thrombocytopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is it recommended to get a PT and PTT preop?

A

PT: alcohol abuse, hepatic disease, malnutrition, bleeding disorder, use of warfarin

PTT: bleeding disorder, undiagnosed hypercoagulable state, use of unfractionated heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is it recommended to get TSH, T3, and T4 levels preop?

A

Goiter

Thyroid disease

Unexplained dyspnea, fatigue, palpitations, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is it recommended to get a pregnancy test preop?

A

Offer to female patient of childbearing age and for whom the result would alter the patient’s management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When does a preop 12-lead ECG have no benefit?

A

Class III:

-routine preop resting 12-lead is not useful for asymptomatic pts undergoing low-risk surgical procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When can a preop 12-lead ECG be considered?
Class IIb: -considered for asymptomatic pts without known coronary heart disease, except for those undergoing low-risk surgery
26
When is a preop 12-lead ECG reasonable?
Class IIa: -reasonable for pts with known coronary heart disease, significant arrhythmia, PAD, cerebrovascular disease, or other significant structural heart disease, except those undergoing low-risk surgery
27
When is it recommended to get an Echo and evaluation of LV function preop?
Patients with: - diastolic murmurs - continuous murmurs - late systolic murmurs - murmurs associated with ejection clicks - murmurs that radiate to the neck or back - grade 3 or louder systolic murmurs LV function: - pts with dyspnea of unknown origin - current or previous HF with worsening dyspnea or other change in clinical status if not performed within 12 months
28
What are the clinical characteristics to consider when deciding to get Pulmonary Function Tests preop?
- Type and invasiveness of the surgical procedure - Interval from previous evaluation - Treated or symptomatic asthma - Symptomatic COPD - Scoliosis with restrictive function
29
What are the predictors of postop pulmonary complications?
- Advanced age - HF - COPD - Smoking - General health status - OSA
30
What are the components of a preanesthesia interview and exam?
1. Introduce yourself and break the ice 2. NPO status 3. Medication 4. Allergies 5. Known medical conditions 6. Past anesthetics -- PONV? Difficult airway? MH? etc... 7. Smoking, alcohol, or drug use 8. Review of systems -- auscultation of heart and lung sounds 9. Airway exam (ask to open mouth wide and protrude tongue -- don't say "ah")
31
What are the NPO guidelines?
8 hours - food and fluids 6 hours - light meal (toast, clear liquids), infant formula, non human milk 4 hours - breast milk 2 hours - clear liquids only
32
What is the STOP-BANG questionnaire? What does it stand for?
An anesthesia preop screen for OSA: - Snoring (loud enough to be heard through closed doors) - Tired (often tired or sleepy during daytime) - Observed (stop breathing during sleep) - Blood Pressure (treatment of HTN?) - BMI (>35) - Age (over 50) - Neck Circumference (>40cm) - Gender (male) *High risk for OSA = yes to 5 or more items
33
When should antidepressant, antianxiety, and psychiatric medications be continued and discontinued on day of surgery?
Should always be continued
34
When should antihypertensives be continued and discontinued on day of surgery?
Generally to be continued Consider discontinuing ACE inhibitors or ARBs 12-24 hr before surgery if taken only for HTN (especially w/ lengthy procedures, significant blood loss or fluid shifts, use of GA, multiple antihypertensive medications, well-controlled BP) *hypotension is particularly dangerous
35
When should Aspirin be continued and discontinued on day of surgery?
Continue: - known vascular disease - drug eluting stents for less than 12 months - bare metal stents for less than a month - before cataract surgery (if no bulbar block) - before vascular surgery - taken for secondary prophylaxis Discontinue 5-7 days before surgery: - if risk of bleeding > risk of thrombosis - surgeries with serious consequences from bleeding - taken only for primary prophylaxis (no known vascular disease, no stents, strokes, or MI)
36
When should Asthma medications be continued and discontinued on day of surgery?
should always continue
37
When should autoimmune medications be continued and discontinued on day of surgery?
Continue methotrexate if no risk of renal failure Discontinue: - Methotrexate if risk of renal failure - Entanercept, Infliximab, Adalimumab -- check with prescriber
38
When should birth control pills be continued and discontinued on day of surgery?
should always be continued
39
When should cardiac medications be continued and discontinued on day of surgery?
generally continued preop
40
When should Clopidogrel (Plavix) be continued and discontinued on day of surgery?
Continue: - Pts with drug eluting stents for less than 12 months - Pts with bare metal stents for less than a month - Before cataract surgery (if no bulbar block) Discontinue 7 days before surgery in everyone not listed above
41
When should COX-2 inhibitors be continued and discontinued on day of surgery?
Discontinue if surgeon is concerned about bone healing
42
When should Diuretics be continued and discontinued on day of surgery?
Continue Triamterene and Hydrochlorothiazide Discontinue potent loop diuretics
43
When should Estrogen compounds be continued and discontinued on day of surgery?
Continue when used for birth control or cancer therapy Discontinue when used to control menopause symptoms or for osteoporosis
44
When should GI reflux medications be continued and discontinued on day of surgery?
Continue use of Histamine antagonists, PPIs, gastric motility agents Discontinue use of particulate antacids (Tums)
45
When should herbals and nonvitamin supplements be continued and discontinued on day of surgery?
Discontinue use 7-14 days before surgery
46
When should Oral DM medications be continued and discontinued on day of surgery?
Discontinue oral hypoglycemic agents day of surgery
47
When should Insulin be continued and discontinued on day of surgery?
``` DM Type 1 -- take 1/3 of intermediate to long acting (NPH, lente) DM Type 2 -- take up to 1/2 long acting (NPH) or combination (70/30) preparations Decrease Glargine (Lantus) if dose is >1 unit/kg Insulin Pump -- continue lowest night time basal rate ``` Discontinue regular insulin (exception insulin pump) and if blood sugar level <100
48
When should NSAIDs be continued and discontinued on day of surgery?
discontinue 48 hours before day of surgery (5 half lives) ** In high risk procedures
49
When should Narcotics or seizure medications be continued and discontinued on day of surgery?
Continue use of narcotics if used for pain or addiction Continue seizure medications
50
When should statins or thyroid medications be continued and discontinued on day of surgery?
both should be continued
51
When should Warfarin be continued and discontinued on day of surgery?
Continue in cataract surgery (no bulbar block) Discontinue 5 days before surgery *typically bridge with heparin (stop heparin 4 hours prior to surgery)
52
When should beta blockers be continued and discontinued on day of surgery?
continue use in patients who take them to treat angina, symptomatic arrhythmias, or HTN
53
When should Steroids be continued and discontinued on day of surgery? How does this affect the HPA?
Take usual dose of steroids on the day of surgery Stress-associated adrenal insufficiency in some patients may require additional steroids periop * HPA is not suppressed with less than 5 mg/day of prednisone or its equivalent -- do not need stress-dose of steroids * HPA is suppressed with more than 20 mg/day of prednisone or its equivalent when taken for more than 3 weeks
54
What characteristics are used to predict difficult mask?
MMMMASK: - Male - Mask seal which is affected by beard or being edentulous - Mallampati grade 3 or 4 - Mandibular protrusion - Age - Snoring and OSA - Kilograms (weight) OBESE: - Obese (BMI >26) - Bearded - Edentulous - Snoring - Elderly (>55)
55
What sleep study determines severity of OSA?
Apnea-Hypopnea Index (AHI) -calculated by dividing the number of apnea events by the number of hours of sleep * Normal = AHI <5 * Mild Sleep Apnea = 5 < AHI < 15 * Moderate = 15 < AHI <30 * Severe = AHI >30
56
What components need to be met before informed consent can be obtained?
1. Competence to understand 2. Voluntary decision making 3. Disclosure of material information 4. Recommendation of a plan 5. Comprehension of 4, 5, & 6 6. Decision in favor of plan 7. Authorization of the plan
57
What are commonly disclosed risks with general anesthesia?
Frequently Occurring/Minimal Impact: - Oral or dental damage - Sore throat or Hoarseness - PONV - Drowsiness/Confusion - Urinary retention Infrequently Occurring/Severe: - Awareness - Visual loss - Aspiration - Organ failure - MH - Drug reaction - Failure to wake up or recover - Death
58
What are commonly disclosed risks with regional anesthesia?
Frequently Occurring/Minimal Impact: - Prolonged numbness/weakness - Post-dural puncture headache - Failure of technique Infrequently Occurring/Severe: - Bleeding - Infection - Nerve damage/paralysis - Persistent numbness/weakenss - Seizures, Coma, Death
59
What are disclosed risks of anesthesia in pediatrics?
Bronchospasms (recent URI) Bruising from IV placement Emergence Delirium
60
What considerations influence the choice of anesthetic technique?
- Coexisting diseases - Site of surgery - Position of pt during surgery - Risk of aspiration - Age of pt - Pt cooperation - Anticipated ease of airway management - Coagulation status - Previous response to anesthesia - Preference of pt - Postop pain control needs
61
What are the three basic types of anesthesia?
General Anesthesia: produces a loss of sensation/perception throughout the entire body Regional Anesthesia: produces a loss of sensation/perception to a specific region of the body Local Anesthesia: produces a loss of sensation to a small specific area of the body
62
What is the definition of Monitored Anesthesia Care (MAC)?
a specific anesthesia service in which an anesthesia provider has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure - LA may or may not be admin by the surgeon or proceduralist - Depth of sedation can range from none to deep sedation - Always be prepared for GA if need be - Not appropriate for uncooperative pts or where pain can't be controlled by topical or LA **MAC does not = Sedation
63
What is considered minimal depth of sedation?
Responsiveness: normal response to verbal stimulation Airway: unaffected Spont Ventilation: unaffected CV Function: unaffected BIS: 80-90
64
What is considered moderate (conscious) depth of sedation?
Responsiveness: purposeful response to verbal or tactile stimulation Airway: no intervention required Spont Ventilation: adequate CV Function: usually maintained BIS: 70-80
65
What is considered deep depth of sedation
Responsiveness: purposeful response to repeated or painful stimulation Airway: intervention may be required Spont Ventilation: ventilation may be inadequate CV Function: usually maintained BIS: 60-70
66
What is considered general anesthesia depth of sedation?
Responsiveness: unarousable even with painful stimulus Airway: intervention often required Spont Ventilation: frequently inadequate CV Function: may be impaired BIS: 40-60
67
What are the components of general anesthesia? Risks?
Immobility, Amnesia, Analgesia - drug induced state, not arousable even by painful stimulus - you must be able to breathe for the pt Risks: aspiration, airway compromise, hypotension leading to CVA, MI, and increased PONV
68
What are they types of regional anesthesia? Risks?
Neuraxial = spinal, epidural, and caudal Peripheral = extremity blocks (cervical, brachial, lumbar, sacral plexus), truncal and chest *avoids risks of GA or can combine with GA for post op pain control Risks: bruising bleeding, infection, nerve injury, LAST, hypotension (spinal/epidural)
69
What are the contraindications of regional anesthesia?
- preference/experience of pt, anesthesia provider, and surgeon - need for immediate postop neurologic exam in anatomic area - coagulopathy - preexisting neurologic disease (MS, neurofibromatosis) - infected or abnormal skin at planned cutaneous puncture site Specific considerations for neuraxial anesthesia: - hypovolemia increases risk of significant hypotension - coagulopathy increases risk of epidural hematoma - increased intracranial pressure may result in cerebral herniation with intentional or inadvertent dural puncture
70
What can you with each Mallampati classification?
I: soft palate, uvula, fauces, pillars II: soft palate, uvula, fauces III: soft palate, base of uvula IV: hard palate only
Scientific Principles
flashcards
Decks in class (16)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions