Pain
Benzodiazepines
Kidneys
Liver
Other Perioperative Considerations II
100
This medication is commonly used as an antipyretic and analgesic in the hospital setting but caution must be used due to its hepatic toxicity
What is acetaminophen
100
Benzodiazepines are frequently used in the inpatient setting to treat which 4 conditions?
What are anxiety/agitation, insomnia, withdrawal syndromes, seizures
100
Every effort should be made to achieve this preoperatively to reduce the incidence of volume-related complications intra and postoperatively.
What is euvolemia
100
Preoperative hepatic impairment increases the risk of postoperative complications, most commonly these 3 things (Name 2 of the 3)
What are infection, bleeding, and worsening liver failure
100
A rare cause of perioperative hypertension is pheochromocytoma, especially if its presence was unrecognized. What medications are recommended to treat the BP in this population?
What are phentolamine or nitroprusside
200
This medication is commonly used postoperatively and in patients with kidney stones. Caution should be used in those with renal impairment, especially in the IM route
What is ketorolac (Toradol)
200
IV administration of these two benzodiazepines are most commonly associated with benzodiazepine related hypotension and respiratory/cardiac arrest. Name one of these.
What are Diazepam(Valium) and Midazolam(Versed)
200
This electrolyte abnormality should always be evaluated and treated in the preoperative setting.
What is hyperkalemia
200
While the Child-Pugh score is the best validated measure of perioperative risk in patients with cirrhosis, this scoring system is also commonly used to predict postoperative mortality.
What is the MELD score
200
DAILY DOUBLE!!! Name 3 of the patient-dependent risk factors for pulmonary complications during/after surgery
What are chronic lung disease (COPD, Interstitial lung disease, pulmonary HTN), Poor general health status, Advanced age, Smoking, OSA
300
This medication is useful in those with biliary disease as it causes less biliary spasm, urinary retention and constipation than morphine. It is contraindicated in patients taking MAO inhibitors and should be used in caution in patient with renal impairment as it can potentiate seizures
What is Meperidine (Demerol)
300
Caution should be used in the sudden discontinuation of benzodiazepines as it may cause not only withdrawal symptoms but this, which can lead to death
What is seizures and delirium
300
This is the most common perioperative cause of acute renal failure in patients with normal renal function prior to surgery.
What is hemodynamic changes
300
Patients with known liver disease should undergo a thorough evaluation including blood work prior to surgery. What labs should be obtained for review? Name 6.
What are hepatic enzyme levels, albumin, bilirubin, coagulopathy, renal function, Ammonia
300
This simple and benign postoperative intervention has been shown to be beneficial in reducing postoperative lung complications.
What is lung expansion maneuvers (incentive spirometry, deep breathing exercises)
400
This medication should be made available for administration in the case of accidental or intentional overdose
What is Naloxone (Narcan)
400
DAILY DOUBLE!!!! This medication should be made available for administration in the case of accidental or intentional benzodiazepine overdose
What is flumazenil (romazicon)
400
As a general rule, dialysis should always be performed in patients with ESRD prior to planned surgical procedures to avoid increased risk of these 5 things. Name 3 of the 5.
What are Hyperkalemia, metabolic acidosis, bleeding diathesis, worsening renal function and volume overload.
400
It is strongly recommended that patients with advanced cirrhosis find nonoperative alternatives for treatment. However, if surgery is undergone, these 6 complications of cirrhosis should be treated prior to procedure. Name 3 of these complications.
What are Coagulopathy, Renal Abnormalities, Electrolyte abnormalities, ascites, encephalopathy and malnutrition
400
Patients taking chronic steroids are at increased risk of developing this intra and postoperatively.
What is adrenal insufficiency
500
Name two other non-opioid medications that are used to treat chronic neuropathic pain
What are Neurontin (gabapentin), Amitriptyline (Elavil), Cymbalta (Duloxetine)
500
These 3 benzodiazepines undergo glucuronidation to inactive metabolites and therefore are useful in the elderly and those with liver disease. Name two of the three.
What are lorazepam(Ativan), oxazepam(Serax) and temazepam(Restoril)
500
This medication is particularly helpful in patients prior to surgery to correct hyperkalemia, especially if they also have hypervolemia.
What are loop diuretics
500
Studies have shown that patients with liver cirrhosis secondary to these 2 conditions tolerate surgery better and have fewer postoperative complications and lower mortality rates. Name one of these conditions
What are primary biliary cirrhosis and primary sclerosing cholangitis
500
Although there is no firm recommendation, it is generally acceptable to consider a preoperative transfusion at what hemoglobin level in the patients with preexisting cardiac disease?
What is less than 9
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