Surgical Management Terms: ASA Therapy & Patient Risks

Which type of antihypertensive should be held the day of surgery?

ACEi

Risks and benefits of discontinuing ___ determine the length of interval that the medication should be discontinued

anticoagulants

Which medication should be held before a CT w/ contrast?

metformin

___ need to be increased before surgery to compensate for the stress response

Steroids

A history of DVT or AFib has a ___ thromboembolic risk than a prosthetic heart valve

lower

Pre-op BMP is used to check on?

- renal dysfunction

- hepatic dysfunction

- DM

- diuretic therapy (K+)

What is a pre-op CBC used for?

- check hgb levels in anemic patients

- hepatic dysfunction

- cancer diagnosis

- dialysis patients

- surgery w/ expected blood loss

Which types of patients should get coagulation labs before surgery?

- patients on recent anticoagulation

- patients w/ hx of bleeding disorder/coagulopathy

- cirrhotic patients

Which study is a good long-term indicator of nutrition status?

albumin

When is a CXR indicated before surgery?

- thoracic surgery

- active lung disease

- concern for metastatic disease

When is an EKG indicated before surgery?

- high risk surgery (major vascular surgery)

- history of cardiac risk (stroke, CHF, CRT>2, DM, ICD)

- no testing needed if low risk surgery

ASA ___ is defined as a healthy patient

I

ASA ___ is defined by mild systemic disease (smoker, pregnant, obese, controlled DM, HTN)

II

ASA ___ is defined by severe systemic disease that is not incapacitating (poorly controlled DM/HTN, hx of MI, CVA, TIA, stent, COPD, ESRD, hepatitis, EF<40%)

III

ASA ___ is defined as severe systemic disease that is constant threat to life (recent MI, CVA, TIA or stent, ongoing cardiac ischemia, EF <25%)

IV

ASA ___ is defined as a moribund patient who is not suspected to survive without an operation (ruptured AA, intracranial bleed, ischemic bowel)

V

A patient that has had an MI within 3 months of surgery has a ___% risk of having an MI during surgery

30

Cardiac evaluation is only worthwhile if testing will ___

change management plan

What tests are done for a 'cardiac clearance'?

- EKG (rhythm)

- Function (Echo)

- Perfusion (stress test)

Which cardiac conditions are worth 5+ points on Goldman's cardiac risk scale?

- third heart sound, JVP

- Recent MI (within 6 months)

- rhythm other than sinus or >5 premature atrial contractions

- >5 PVC's

- age >70y/o

When should ASA therapy be stopped prior to surgery?

7-10 days

Which situations require a DAPT bridge?

- <2 weeks PTCA

- <6 weeks MI

- <6 weeks BMS

- <6 months DES

- <12 months DES w/ high risk stent thrombosis

What are surgical risk factors for pulmonary concerns?

- thoracic surgery

- upper midline abdominal surgery

- general anesthesia (decreases FRC by 11%)

Patient risk factors associated with pulmonary concerns?

- smoking

- asthma

- COPD

- obesity

- OSA

An FEV1 of ___ carries a significant risk that patient will not be able to extubate after surgery

<0.8

What are post surgical issues associated with patient that have cirrhosis?

- ascites

- coagulopathy

- encephalopathy

- fluid shifts

Which scores should be calculated in patients with Cirrhosis?

- Child Pugh

- MELD

What are some issues that patients with renal disease can have post operatively?

- hyperkalemia

- metabolic acidosis

- fluid balance issues

- vascular access issues (dialysis)

Patients with adrenal insufficiency are at risk of what complications post surgery?

- increased risk of infections

- hyperglycemia

- impaired healing

- stress dosing steroids needed for moderate to major surgery

Why are patients placed on NPO before surgery?

decrease risk of aspiration

What are risks of any surgery?

- bleeding

- infection

- injury to other structures

- surgery specific risks

- anesthesia related risks (MI/stroke/PE/death)

Difference between type and screen and type and cross?

- type and screen is not on hold for a particular patient and is not mixed with the patients blood

- type and cross is on hold for a specific patient and is mixed with the patients blood

What are some things that should be checked post-operatively?

- pain control

- nausea

- vital signs

- urine output

- drain output

What are some causes of post operative hypotension?

- hypovolemia

- medications

- hemorrhage

- septic shock

- cardiogenic shock

- anesthesia

Which tests/vitals should be reviewed for hypotension post operatively?

- UOP

- CBC

- med reconcilliation

- cardiac enzymes

- EKG

POD 1 what are some common causes of postoperative fever?

- atelectasis

- SIRS

POD 3-5 what are some common causes of postoperative fever?

- iatrogenic causes

- UTI

- Pneumonia

- wound infection

POD 6-7 what are some common causes of postoperative fever?

- surgical site infection

What are some postoperative causes of shortness of breath?

- atelectasis/hypoventilation

- pulmonary edema

- pneumonia

- pulmonary embolism

- cardiac causes

What are some causes of altered mental status post operatively?

- medications

- hypoxia/hypercarbia

- withdrawal

- electrolyte abnormality

- CVA

- sepsis

- dementia/ICU delirium

What is the workup for AMS after surgery?

- ABG

- head CT

- infection workup

- med reconcilliation

- BMP

What is the workup for SOB postoperatively

- PE

- EKG/troponins

- CXR

- ABG

- CTA if XR normal

A patient that has had an MI within 3 months of surgery has a ___% risk of having an MI during surgery

30