Pre-Anesthetic Assessment - Quiz 7

What are the parts of the pre-anesthetic assessment?

1) complete medical/dental history

- evaluate concomitant meds

2) physical examination

3) physiological examination

What should the physical examination for the pre-anesthetic assessment include?

1) visual exam

- observe posture, movement, speech etc

2) Take BP

3) Take Pulse and RR

4) Record patient's weight

What blood pressures goes with the following?

- consider nitrous oxide for stress

- refer to med consult before tx

- refer for immediate med consult

- 140-159/90-94 (consider nitrous)

- 160-199/95-114 (refer for med consult)

- >200/115 (immediate medical consult

What are acceptable heart rates for adults; children & toddlers?

adults: 60-100

children: 75-100

toddlers: 120-160

What are acceptable respiratory rates for adults; children & toddlers?

adults: 12-20

children: 18-30

toddlers: 25-32

What is the rule when determining dosage for overweight children?

ALWAYS use less than then MRD regardless of weight due to their immature liver

What signs may indicate moderate anxiety during a physiological examination?

1) quick answers

2) "too cooperative"

3) sitting on their hands

4) "white knuckle syndrome"

5) nervous conversation

6) nervous "play"

What is the protocol for stress reduction?

1) adequate pain control

explain advantages of LAs to patient

2) ↓pain of an injection

3) select an LA of appropriate duration

What effect does stress have on the body?

decreases pain reaction threshold

What is the difference between absolute and relative contraindications?

absolute: do not administer under any circumstances (life threatening)

relative: administrator judiciously if no alternative drug is available

What is the ONLY absolute contraindication to LAs?

allergy to LAs

What disorder/drugs present contraindications for articaine & ester-based topicals

and why

Absolute contraindication:

1) patients on cholinesterase inhibitors

- ↑systemic toxicity

2) atypical plasma cholinesterase

- ↑↑↑systemic toxicity

Relative contraindication:

1) patients on sulfonamides

- ↓antibacterial action of sulfa

What anesthetics should be used if a patient is pregnant?

prilocaine or lidocaine

What relative contraindications call for a ↓dosage of all amides

1) taking beta blockers

2) significant liver disease

3) taking CNS depressants

4) history of malignant hypothermia

med consult for this one as well

What should be done for a patient taking H2-receptor blockers?

↓dosage of lidocaine due to ↓liver metabolism

What should be done for a patient with renal dysfunction?

and why

use anesthetics with care due to slight risk of toxicity, as all anesthetics are excreted in the kidneys

What vasoconstrictors are absolute/relative contraindications for tricyclic antidepressants

and why

absolute contraindication: levonordefrin

relative contraindication: EPI

increases BP and enhances arrhythmias

What vasoconstrictors is relative contraindications for nonselective beta blockers?

and why

relative contraindication: EPI + Levo

increase BP and decreases HR

What vasoconstrictors are absolute/relative contraindications for digitalis glycosides

what is it prescribed for

absolute contraindication: EPI w/out physician approval

relative contraindication: EPI with physician approval

prescribed for arrhythmias + CHF

increased potential for arrhythmias

What vasoconstrictors is relative contraindications for phenothiazides?

and why is it prescribed

relative contraindication: EPI

*prescribed for psychosis or severe nausea (chemo patients)

decreases BP

What vasoconstrictors are absolute contraindications for illegal recreation drugs?

why'

wat kind of illegal drugs

absolute contrainidication: EPI & Levo

specifically methamphetamine & cocaine

severe increase in BP+HR, can possibly cause CVA or MI

What systemic disease are absolute contraindications for vasoconstrictors?

1) MI within 6mos

2) coronary bypass surgery within 6mos

3) uncontrolled hypertension

- meds changed within the last 3mos

4) uncontrolled angina pectoris

- daily attacks or attacks at rest

5) uncontrolled arrhythmias

6) uncontrolled hyperthyroidism

7) sulfite allergy

8) methamphetamine or cocaine abuse

9) pheochromocytoma (adrenal tumor)

What systemic disease are relative contraindications for vasoconstrictors?

1) CV disease

2) hyperthyroidism

3) asthma

- due to 10% bisulfite allergy

What is the cardiac protocol for vasoconstrictors?

MRD of .04mg EPI or .2mg LEVO

NO 1:50,000 epi

What patients should cardiac protocol be carried out for?

1) CV disease patients

2) patients taking non-selective beta blockers

3) patients taking phenothiazines

4) patients taking tricyclic anti-depressants

- NO LEVO for these patients either

5) uncontrolled diabetics (HbA1c: 9+)

- needs to be limited due to healing issues

6) patients taking digitalis

- consults physical before using