Term
| How many ASA grades are there? |
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Definition
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Term
| A person with mild asthma would be an ASA of? |
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Definition
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Term
| What are the most common ASA classes you will work with |
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Definition
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Term
| A patient with renal failure on dialysis is an ASA? |
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Definition
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Term
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Definition
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Term
| If a person has comorbities that are a significant impact on dialy activity are ASA? |
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Definition
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Term
| what is the difference between ASA 3 and 4 on daily activity |
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Definition
| ASA 3 have some signifant restrictions on daily living but ASA 4 have serious limitations. |
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Term
| What is the difference between ASA 5 and 6? |
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Definition
| ASA 5 patient will likely die in 24 hours with or wihtout surgery. ASA 6 patient is a brain dead organ donor. |
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Term
| Whats a better MET score. 3 or 12? |
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Definition
| 12! Means you can run as fast paces for long distances |
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Term
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Definition
| Each MET is equivalent to your body being able to consume 3.5 mLO2/kg/min of body weight. The higher the MET score 1-12 the more likely someone can handle large amounts of metabolism without stress on their heart/lungs. |
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Term
| what type of valve problems would make you want to cancel the case |
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Definition
| severe AS or MV disease or stenosis |
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Term
| What is a good MET score to go into a surgery |
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Definition
| equal to or > 4 METS (Means your can rake leaves and walk up and down stairs |
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Term
| define systolic dysfunction |
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Definition
| decrease ejection fraction from abnormal contractility |
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Term
| define diastolic dysfunction |
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Definition
| increased filling pressures with abnormal relaxation but normal contractility and EF. |
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Term
| +++ Accounts for half of all cases of heart failure |
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Definition
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Term
| What can cause diastolic dysfunction (one of many) |
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Definition
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Term
| If you see this on ECG you should suspect a degree of cardiac diastolic dysfunction |
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Definition
| left ventricle hypertrophy. Ventricle has to get bigger to compensate for poor filling from dysfunctioning diastole |
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Term
| 50-75% of systolic dysfunction heart failure stems from |
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Definition
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Term
| What type of murmur is always pathological and requires evaluation |
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Definition
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Term
| Is regurgitant heart disease tolerated better perioperatively or is stenotic disease? |
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Definition
| Regurgitant heart disease is better tolerated |
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Term
| does aortic scelrosis casue hemodynamic compromise |
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Definition
| NOOOO. May sound the same as AS but not dangerous like AS |
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Term
| What varieties of murmurs may warrant getting an ECHO |
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Definition
1. Diastolic murmurs
2. continuous murmurs
3. Late systolic murmurs
4. Grade 3 or louder systolic murmurs |
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Term
| a preoperative BP < ?/? is not associate with perioperative cardiac risks |
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Definition
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Term
| Is asthma a predictor of difficult perioperative management |
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Definition
| NO. IF ASTHMA IS WELL CONTROLLED no risk. But if not well controlled or wheezy at induction that is a risk. |
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Term
| what can you do preoperatively to decrease risks associated with bad asthma or COPD patient |
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Definition
| give albuterol or a inhaled steroid preoperatively. Shown to decrease risks!! |
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Term
| Do arterial gases, CXRs or pulmonary function tests offer good indcators of potential postop pulmonary complications? |
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Definition
| NOOOOOOOOOOOOO. The only to help with prevent post op pulmonary complications is to treat major issues like HF, COPD, preop. |
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Term
| What is STOP-BANG stand for? |
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Definition
STOP-BANG
1. Snoring
2. Tired
3. Observed apnea
4. Pressure HIGH BP
5. BMI >35
6. Age >50
7. Neck circumference > 40cm
8. Male Yes is bad. |
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Term
| STOP BANG IS USED FOR? What is a + indicator |
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Definition
| Used to assess for OSA. Score yes to more than 3 items and you have OSA. |
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Term
| You should only order a preoperative test if? |
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Definition
| if the results will impact the decision to proceed with the planned procedure or alter the plans. |
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Term
| random EKG preop are not indicated unless patient has one of hte following |
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Definition
1. ischemic heart disease
2. HF
3. Cerebrovascular disease
4. DM
5. Renal insufficency
6. Some vascular procedures |
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Term
| ASA can effect bleeding times by a factor of? But either way surgeons could not tell the difference in a double blind study. The only procedures you don't want patients on ASA are |
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Definition
1. increase bleeding by 1.5 factor
2. Don't give if patient undergoing intracranial or transurethral resections of the prostate. |
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Term
| ASA can be discontinued if taken only for primary or secondary prevention? |
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Definition
| Primary!! Which is prevention not for actual disease presence |
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Term
| can patients on ASA safely get neuraxial anesthesia? |
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Definition
| YES. Endorsed by american society of regional anesthesia. |
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Term
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Definition
| Stop LMWH 12-24 hours before procedures. Increase risk of bleeding in neuraxial blocks |
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Term
| Warfarin before surgery.. what to do |
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Definition
| If pt has an INR 2-3 and is stable on warfarin then you can safely hold 5 doses prior to surgery and that should be effective. Recheck 2 days out. But if their INR >3 you may need to hold more doses prior to surgery. |
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Term
| Bridging people from warfarin to heparin IV is reserved for? |
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Definition
| people with acute thrombotic issues 1 month or sooner or other acute or risk diseases |
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Term
| patients with DES of what duration need to continue their plavix? |
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Definition
| if DES in <12 months need to continue plavix! |
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Term
| NSAIDS should be continued day of or stopped? |
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Definition
| Stop 48 hours prior to surgery |
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Term
| patients with insulin pumps should do what on surgery day |
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Definition
| continue basal rate but stop all short acting insulin |
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Term
| metformin considerations preop and postop |
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Definition
| Can give day of surgery will not cause hyopglymcemia is fasting patient. But do not restart metformin for several days since it is assocaite with lactic acidosis and needs liver for metabolism. Need to first make sure there is no acidosis from the surgery itself. |
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Term
| what is the normal adrenal ouput of cortisol which is equivalent to how much predinsone? |
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Definition
| 30mg cortisol by body equals 5-7.5 mg of predinsone |
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Term
| what dose of steroids such as predisone can cause hypothalamic-pituitary axis to become suppress and therefore these patients may need stress dose steroids to compensate for surgery when patient HPA is suppressed from chronic steroids |
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Definition
| a pt on more than 20mg/day of predinson for more than 3 weeks can cause adrenal insufficiency that lasts up to one year after the cessation of the steroids. |
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Term
| MAOI and surgery..what to know? |
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Definition
| MAOI have long half life of 3 weeks. If you discontinue them three weeks in advance you place patient at high risk of suicide and depression. So just continue MAOI and tailor anesthesia plan for this. |
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Term
| patients can have clear liquids up to how many hours prior to surgery |
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Definition
| 2 hours if no other risk factors |
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Term
| Conditions that increase risk of aspiration |
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Definition
1. delayed gastric emptying
2. incompetent LES w/reflux
3. hiatal hernia
4. DM
5. gastric motility disorder
6. intra-abdominal masses
7 bowel obstruction |
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Term
| Describe physiology of diastolic dysfunction and what causes it |
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Definition
Diastolic dysfunction occurs when your left ventricle is stiff / possible from hypertrophy and can no longer relax as easily during distole. As a result there is decrease compliance and when blood passively enters the ventricle it meets higher resistance. Therefore there is more pressure during diastole, hence why we call this increase filling pressures. Overall the period known as diastole is in dysfunction becasue the heart cannot relax normally and allow blood to passively flow normally.
Diastolic dysfuction is normally caused by disease that force the left ventricle to get bigger which eventually leads to a dysfunction in diastole. The LV gets bigger when theres incrase Afterload from stenotic valves, or HTN. |
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Term
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Definition
| skeletal muscle relaxation and loss of motor reflexes. |
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Term
| at what stage of anesthesia do you loose your eye lash reflex |
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Definition
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Term
| at what stage of anesthesia do you loose your swallow reflex |
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Definition
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Term
| What stage of anesthesia do you loose your eyelid reflex |
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Definition
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Term
| What plane of stage III, plane 3 anesthesia do you begin to have intercostal muscle paralysis. BUT NOT COMPLETE. |
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Definition
Plane 3.
- Complete occurs in stage III, plane 4. Complete intercostal paralysis results in apnea. |
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Term
| what plane of Stage III do we want? What Sx should we look for |
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Definition
| Stage III Plane III is ideal. Here we have pupil dilation and loss of pupil reflex to light. **pupils go from dilation during stage II to constriction in the first phase of stage III. And then back into a dilation phase. |
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Term
| Somebodies eye begin to lacriminate what stage are you in |
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Definition
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Term
| Why should an epidural not give a spinal headache? |
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Definition
| They are in the epidural space and never pierce the dura which is associated with "spinal headaches". But if you get such a headache may be an indication you are in the WRONG SPACE. |
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Term
| what considerations should you have for people with a bare metal stent |
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Definition
| If bare metal stent <1 month then they have to take plavix and ASA. |
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Term
| what findings indicate you entered plane 4 of Stage III of inhaled aneshtesia ?????? |
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Definition
| Not good. Risky place to be. You will have apnea since at this plane you have COMPLETE intercostal muscular paralysis. |
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Term
| a BIER block is good for how long? |
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Definition
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Term
| why would you consider d/c preop cox2 inhibitors |
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Definition
| if patient at risk for bone not healing. |
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Term
| when should you consider stopping viagro preop |
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Definition
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Term
| what are the different doses of hydrocortisone you should give if a patient is at risk for depressed HPA hypothalamus - pituitary axis |
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Definition
25mg Hydrocortison for minor
50-75 mg hydrocortison for moderate surgeries
100mg-150 mg hydrocortisone for major. |
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Term
| what is dolestron and how much do you give |
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Definition
| AKA anzemet is a serotonin selective blocker. The dose is 12.5 (equivalent to 4mg zofran). It lasts longer than zofran but overall is the same. |
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Term
| where is the vomiting center located? |
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Definition
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Term
| What is a normal functional residual capacity of an adult that you are attempting to fill with oxygen? How do you get the pt to breath to achieve the best preop intubation O2 capacity |
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Definition
| 2500mL of 21% oxygen. Give 100% of O2 with eight vital capcity breaths. Allows you to have a larger increase in margin of safety. |
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Term
| Why do you give an opioid prior to intubation |
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Definition
| to blunt the SNS HTN/HR response to direct laryngoscopy and intubation |
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Term
| Time to onset of paralysis after sux |
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Definition
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Term
| Why might sevo be indicated for induction over other induction methods? |
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Definition
| It does not have side effects of salivation and it preserves spontaneous breathing. Once induction parameters are met, give your paralytic and then intubate |
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Term
| Does opioids or benzos cause apnea |
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Definition
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Term
| what dose of sevo would you give for induction and how long will it take |
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Definition
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Term
| what are the four main objectives of maintenance of anesthesia |
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Definition
1. amnesia
2. analgesia
3. skeletal muscle relaxation
4. control of SNS to noxious stimulation |
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Term
| what are three types of neuraxial regional anesthetic |
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Definition
1. spinal
2. epidural
3. caudal |
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Term
| why is spinal better than epidural? What are the disadvantages of spinals |
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Definition
Advantage of spinal:
1. takes less time to perform
2. produces more rapid onset and better quality of effect
3. is associated with less pain during surgery
Disadvantages:
1. postspinal headache
2. risks of intrathecal in arachnoid space. |
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Term
| mortality rate of anesthesia is? |
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Definition
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Term
| if a person is worried about anesthesia what can they do prior to surgery to improve their chances of having limited to no complications? |
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Definition
1. stop smoking
2. loose weight |
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