Why is Preop Evaluation Important?
True or False? Low risk patients are at Greatest risk of perioperative complications
False
The year that this important system of surgical patient risk was first published?
1941
Name 4 preop medications commonly used for anxiolysis
Benzodiazepines
Antihistamines
Clonidine
Anticholinergics
What category of patients do the ASA 2017 and 2023 modular update on fasting guidelines refer to?
Healthy patients
(no DM, No obesity, no GERD etc., so really no JHH patients)
FEV1 and DLCO >/= 80%
Low risk of pulmonary complications and will tolerate lobectomy without residual dysfunction
The best time to quit before surgery
Any time, the sooner the better
•Despite intraop mortality decreasing by a factor of 10, this remains high.
perioperative m&m
In 1941, these specialists were tasked with "arbitrarily" deciding when a surgical procedure should be performed without delay.
Surgeoans
Name 4 preop medications used for analgesia
APAP
Narcotics
Ketamine
AED’s
To avoid prolonged fasting in this group of patients, efforts should be made to allow clear liquids as close to 2h before procedures as possible.
Healthy children
Is patient able to:
Take care of self, Walk indoors, walk 1-2 blocks on level ground, Climb a flight of stairs, Run a short distance, do light work around the house, Do moderate work around the house, do heavy work around the house, Do yardwork, have sexual relations, participate in Moderate recreational activities participate in strenuous sports
DASI
assessment of 4 METS activity
42.1 million US adults
Smoker, 18% of population
If this was classified •as a disease, it would be in the top 5 leading causes of death in the U.S.
perioperative mortality
In 1941 this class patient risk was assigned to represent conditions that represented an eminent threat to life regardless of the type of treatment
ASA 4
Routine use of this antiemetic is in the 2017 ASA Preoperative Pharmacologic Recommendations
None are recommended routinely
The advised delay for elective cases in patients who arrive to the hospital chewing gum.
No delay. Remove gum prior to induction, and proceed as usual
Benefits of Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest
Age, functional status, ASA Class, Creatinine, Type of procedure
(derived from NSQIP)
Few (<1%) of patients suffer perioperative major cardiac events, but 30-day mortality in this population is high (61%).
Identify higher risk patients who will benefit from pre-operative medical cardiac optimization is important.
Preop counseling/informed consent
increased odds of MI, stroke, respiratory events and death
Perioperative complications associated with smoking
The 30 day post-op mortality after non-cardiac surgery for inpatient surgery in the U.S.
1-2%
The ASA Committee that developed the latest (2014) amendment to the Physical Status Classification System.
Committee on Economics
Per 2017 ASA Preoperative Pharmacologic Recommendations, this common GI stimulant may be used.
Metoclopramide
Clear liquids containing simple and complex carbohydrates have been shown to have these beneficial effects.
Reduce thirst and hunger.
Accurately risk-stratifies patients and helps patients understand individualized cardiac risk prior to undergoing surgery, which can be helpful in discussions of informed consent.
In patients with elevated risk (score ≥1, age ≥65, or age 45-64 with significant cardiovascular disease), helps direct further preoperative risk stratification (e.g. with serum NT-proBNP or BNP) and determine appropriate cardiac monitoring post-op (EKG, troponins).
RCRI
This substance in smoke causes myocardial ischemia
CO
This can have long-term consequences and impact Quality of Life.
Post-op organ dysfunction
The current PS classification for a nonverbal child with autism.
ASA III
T or F
Sodium Citrate is routinely recommended as an antacid by the ASA
False
The length of time suggested to wait after drinking clear, protein containing liquids necessary to prevent pulmonary aspiration in healthy patients.
2 hours
Estimates 10 year risk of heart attack in patients aged 30-79 with no prior history of CAD. Not to be used in patients with Diabetes/claudication
Considered "old" may not reflect today's population
Framingham Risk score
Putative cause for association of chronic pain and smoking
nicotinic receptor downregulation
This is a consequence of the "graying" of our population.
Surgical patients acquire more comorbidities/ complexity of their care increases
The current PS classification for a parturient with cardiomyopathy (EF <40%)?
ASA IV
Which anticholinergic agents are routinely recommended by the ASA as premedications?
None
1123
How to manage newer hypoglycemic medications in the perioperative period.
GLP-1 agonists- hold 1 week or 1 day (routine dosing schedule
SGLT-2i's - hold 3 days
Can help determine the 1 year risk of TE event in a non-anticoagulated patient with non-Valvualr AF.
Used for a guide to start Bridge therapy for DOAC patients.
CHADS2-Vasc
This may mitigate increased pain observed in smokers
Nicotine replacement in smokers