Risk Factors
The overall risk for serious medical complications from surgery in healthy patients
What is less than 0.1%
Group of people should undergo preoperative evaluation
**ALL PATIENTS**
How long to stop aspirin prior to surgery
3-5 days
Name a rheumatologic drug that is safe to continue for noncardiac surgery.
Hydroxychloroquine, methotrexate, leflunomide, and/or sulfasalazine
Which of the following surgical procedures has the highest perioperative risk?
A. Endovascular aneurysm repair
B. Esophagectomy
C. Hip and spine surgery
B. Esophagectomy
What are the essential elements of preoperative history and physical examination?
What are the Patient's age, medication use, exercise intolerance substance use, comorbidities and experience with anesthesia
When should NSAIDs be stopped prior to surgery?
Typically 2-3 days
In patients with HF, which drug regimen should the patient be on prior to surgery?
A b-blocker, an ACEi, an angiotensin receptor-neprilysin inhibitor combinarion, and a diuretic.
How many grades of physical status are present in the american society of anesthesiologists?
A. 6
B. 5
C. 4
What is 5
Patient given halothane prior to surgery. She begins to experience muscle contractions with a rapid rise in body temperature.
Malignant Hyperthermia
When should diuretics, ACEi, ARBs be stopped prior to noncardiac surgery.
The day of the procedure
Postoperative arrhythmias occur in what percentage of patients that undergo noncardiac, nonthoracic surgery?
a. 3%
b. 5%
c. 10%
3%
What is the optimal timeframe to stop smoking prior to surgery?
AS SOON AS POSSIBLE
Tools recommended to assesss for major adverse cardiac events.
Revised Cardiac Risk Index
The American collegeof surgeons NSQIP
and/or the MI/cardiac arrest tool
Deep breathing exercises and incentive spirometry
In a patient with Liver disease, which criteria/risk estimation tools are useful for predicting perioperative mortalility.
Child-Pugh criteria
MELD score
**Mayo Clinic risk prediction tool
**VOCAL-Penn score
Questionaire used to screen for obstructive sleep apnea prior to surgery.
STOP-Bang.
When should noninvasive cardiac testing be avoided? ie what type of patient does not not require test?
Patients with elevated cardiac risk or poor functional status where the results are unlikely to change management.
Through meta-analysis, perioperative beta blockade have been associated with what adverse effects?
Bradycardia, hypotension, and stroke
*Of note, b-blockade has been associated with reduced MI ad nonfatal MI
Which oral hypoglycemic medication class should be held three days prior to surgery.
SGLT-2 inhibitors
**Of note, Ertugliflozin is an SGLT-2 inhibitor that requires 4 days of being held prior to surgery