Surgery Type/Pre-op
A pt calls in to your office and asks what they are allowed to eat before their operation tomorrow where they will be put on anesthesia. What would you tell this patient?
You can have clear liquids up to 2 hours before your surgery.
Stop eating solid foods 6 hours before your surgery and fatty foods 8 hours before.
Bonus Q: What is the medical abbreviation for not eating or drinking anything orally?
A patient comes in to have a non-cancerous mole on their back removed. What surgery classification would this be considered?
Elective. This surgery is being performed based on patient choice and is not essential.
What is the Aldrete scoring system?
A system used to monitor recovery after anesthesia.
Bonus Q: Are higher or lower scores better and what score means the pt is ready to be transferred?
Heparin and warfarin are often given after surgery. Which is measured by PT, PTT, or INR?
Heparin is measured with PTT (intrinsic).
Warfarin is measured with PT and INR (extrinsic).
Bonus Q: Why are these medications common after surgery?
A pt is curious about the different ways people can receive general anesthesia. What are 2 ways anesthesia can be delivered to a pt?
-inhaled
-intravenous
Bonus Q: Which is considered a volatile anesthetic?
Extra BQ: What are the 2 inhaled anesthetics we’ve learned about?
A pt comes in to have surgery. You are in charge of the teaching and education for this pt. What are at least 3 topics you would want to discuss with them?
-review the surgical procedure (type of anesthesia)
-discharge requirements (having an adult be w/ them for 24 hrs)
-pain management post-op
-anesthesia effects
-what they’ll feel post-op (health trajectory, recovery expectations)
-etc…
A patient comes to the ER and is diagnosed with acute appendicitis. The doctor decides they need an immediate appendectomy or it could burst can cause a life-threatening infection. What surgery classification would this be?
Emergent. This surgery must be done immediately.
What could be symptoms of blood loss/hemorrhaging?
-lowered systolic blood pressure
-tachycardia
-increased capillary refill time
-decreased urine output
What are signs of malignant hyperthermia?
-muscle rigidity
-very high fever
-increased CO2 production
-hyperkalemia
-tachycardia
Bonus Q: What medication can we give to help treat this?
What are the 4 stages of anesthesia?
Analgesia, can follow commands, mild conscious sedation
Excitement and hyperactivity, VS instability, typically only lasts a short period of time
Loss of consciousness, paralysis, VS slow/stable
Too much sedation - suppression of medulla, need cardiac and respiratory help
Bonus Q: What are the 3 reversal agents/antidotes we are learning about?
A pt comes in a year after a traumatic car accident that caused facial disfigurement. They are receiving plastic surgery to help restore their face to what it looked like before the accident. What type of surgery would this be considered?
Reconstructive surgery.
Bonus Q: Why would this not be considered constructive surgery?
A patient has cataract surgery performed on both eyes to help them see better. What classification of surgery would this be considered?
Elective. This surgery is being performed based on patient choice and is not essential.
What are at least 2 potential complications of general anesthesia?
-malignant hyperthermia
-overdose
-hypoventilation
-confusion
What is the purpose of a drain being placed in a pt after surgery?
To drain exudate from the wound site, which promotes healing and reduces swelling.
Bonus Q: define exudate.
What could cause malignant hyperthermia if you have the genetic predisposition?
-volatile anesthetics (-flurane)
-succinylcholine
-caffeine (high doses)
-exertion in very hot environments
Bonus Q: What is the pathology behind malignant hyperthermia and what symptoms will the patient experience?
What are the 6 types of surgery?
-diagnostic
-corrective/ablative
-reconstructive
-procurement for transplant
-constructive
-cosmetic
Bonus Q: What is the definition of ablative/ablation?
Extra BQ: What is corrective/ablative surgery?
What are the 4 different classifications of surgery need? Define each.
Elective: performed on pt choice; not essential and may not be necessary for health.
Urgent: necessary for pt health; may prevent additional problems from developing; not necessarily emergent
Emergent: must be done immediately to save life or preserve function of a body part
Required: must be performed at some point; can be pre-scheduled
What is often the first vital sign affected by changes in cardiac or neurologic status?
Respiratory rate and function.
Bonus Q: Why might we be particularly caution when a pt uses the bathroom after surgery?
Why is hypotension a rather common side effect after surgery? (At least 3 reasons)
-large amounts of IV fluid
-ventilation with dry gas
-OR is cold
-vasodilation from anesthesia
-general anesthesia impairs autonomic temperature control
Bonus Q: What are some complications that can come from being hypothermic?
What is the difference between how benzodiazepines and barbiturates affect GABA chloride channels?
Benzos: increase the frequency of the chloride channels opening
Barbs: keel the chloride channels open longer
Bonus Q: What is the generic name of the barbiturate drug we’re studying?