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2 reasons for anesthesia conuslt:
- 1) reduce surgical and anesthetic morbidity/mortality
- 2) return pt to desirable level of functionality asap
Stress Response to surgery proportional to:
- magnitude of injury
- total operating time
- amt of blood loss
- degree of post op pain
decreasing stress response to surgery and trauma is _______ to _________ outcome and lowering length of _______ and total cost of pt's care.
- hospital stay
History should include all of the following: (8)
- 1. Medical hx (past/current)
- 2. Surgical Hx
- 3. Family hx
- 4. Social hx
- 5. Allergies
- 6. Drug therapy (recent/current)
- 7. drug reactions, anesthesia complications
- 8. family hx of anesthesia adverse rx
a physical exam should build on the information gathered during the ______.
Describe focused pre-anethesia physical exam:
- airway assesment
- lungs and heart w/ documentation of vital signs
unexpected abnormal findings on PE should be ________ before ________ surgery
what are the indication for getting an INR lab?
- Anticoag therapy
- bleeding diathesis
- liver dz
What are the indication for getting an complete blood count lab?
- chronic cv, lung, renal, hepatic dz
- anemia, bleeding condition, myelosuppression
- < 1 year of age
What are the indication for getting a fasting glucose lab?
DM (on day of surgery and prior to)
What are the indication for getting an EKG before surgery?
Heart dz, HTN, DM, cardiac dz, age, cranial hemorrhage, cerebrovascular accident, head trauma
What are the indication for getting a chest radiograph?
- cardiac or pulmonary dz
Most drugs should be continued up to and the day of surgery. what are the exceptions?
- Herbal supplements
- Oral anticoags
- anti-HTN:diuretics, ACE inhibitors/ARBs
- diabetic meds: oral and insulin
how before surgery should a pt stop taking MAOIS?
how before surgery should a pt stop taking OCPs?
6 weeks. risk of venous thrombosis
how before surgery should a pt stop taking Aspirin?
how before surgery should a pt stop taking thienopyridines?
how before surgery should a pt stop taking oral anticoags? INR should be ____ prior to surgery.
severe systemic dz that is a constant threat to life
moribund, not expected to survive without surgery
brain-dead, organ removal for donor purposes
What are the MAJOR risk factors for perioperative complications?
- Recent MI
- unstable angina
- significant arrhythmias
- severe valvular dz
What are the MINOR risk factors for perioperative complications?
- advanced age
- abnormal ECG (LVH, LBBB, ST-T-wave abnormalities)
- Rhythm other than sinus
- Poor functional capacity
- hx of stroke
- uncontrolled HTN ( d> 110)
Pt's are high risk for ___ days after coronary revascularization.
What surgeries are considered low risk for cardiac complications?
- plastic, reconstructive
PPC's occur in ____% of pt's undergoing major, non thoracic surgery
Name the PPC's
- resp failure with prlonged mechanical vent
- exacerbation of underlying chronic dz
risk factors for PPC's
- proximity to diaphragm
- length ( >3 hours)
- chronic pulmoary problems
- >60 years
- Sleep apnea
- poor exercise tolerance
_____ have a higher incidence of death after an MI.
Pt's with DM- consider giving what? why?
- beta blockers
- ischemia, silent MI
It is important to control what with diabetic pt's?
What procedures don't need to alter anticoag therapy?
dental, arthrocentesis, biopsies, ophthalmic operations, endoscopy (diangnostic)
regarding anticoag- invasive surgery generally safe if INR is ____.
it takes ___ days for INR to reach 2.0 once oral anticoag started postoperatively