Pre & Post Op Evaluation - Clin Med 6

What does this refer to

• pre-anesthetic evaluation should be made several days in advance.

• Testing for lung function

• Testing for other body systems that affect lungs. (kidneys, heart, cranial nerves, etc)

Pre-operative

What does this refer to

• Any medical history of complications previously

• Any concerns with overall health during surgery

Perioperative

What does this refer to

• Is the patient able to recover from surgery, respiratory related? Will they need more assistance with the pulmonary system after surgery?

Post-Operative

What does this refer to

• Pre-op is performed to assess patient for surgical candidacy

Evaluation

What does this refer to

• What medical history does the patient have that may put their health at risk if they are cleared for surgery?

Risk

What does this refer to

• Is there any additional complications that may occur with this patient and not with a healthy individual?

Complication

What does this refer to

• H&P

  • Essential tool in estimating severity of pulmonary compromise and extent of pulmonary reserve.

  • S/S of important clues to the pulmonary status pre-operatively.

    • Heart Failure

    • OSA

• Determination

  • Base on symptoms of cough, SOB, dyspnea, recent lung infections, COPD, can the patient walk normally, fluid retention, edema

  • Medical History-Smoker, Asthma

  • Concerning-Self-reported symptoms, extensive smoking hx (>20pk/yrs), maximal laryngeal height <4cm or less and <45 years of age.

Estimate the risk

What does this refer to

• Essential tool in estimating severity of pulmonary compromise and extent of pulmonary reserve.

• S/S of important clues to the pulmonary status pre-operatively.

  • Heart Failure

  • OSA

H&P (to estimate the risk)

What does this refer to

• Base on symptoms of cough, SOB, dyspnea, recent lung infections, COPD, can the patient walk normally, fluid retention, edema

• Medical History-Smoker, Asthma

• Concerning-Self-reported symptoms, extensive smoking hx (>20pk/yrs), maximal laryngeal height <4cm or less and <45 years of age.

Determination (to estimate the risk)

What does this refer to

Determinates

What type of procedure is the top box

Low risk procedure

What type of procedure is the middle box

Intermediate Risk Procedure

What type of procedure is the bottom box

Vascular, Renal risk, or emergent procedures

What does this refer to

Recommended labs based on medical history

What does this refer to

• Goal of ____________ is to help the patient to arrive to the operating room with sedation, hypnosis, prevention of nausea and vomiting, and with preemptive analgesia

Pre-Anesthetic Medication

What does this refer to

Approach to patient with cough

What does this refer to

Approach to patient wheezing

What does this refer to

Approach to patient with dyspnea

What does this refer to

• Benzo

• Melatonin

• Doperidol and Decadron

Pre-Anesthetic Medication

What does this refer to

Medication not to continue prior to procedures (may be taken on day of surgery)

What does this refer to

Sleep Apnea

What does this refer to

• Pulmonary function testing

• Labs

• EKG

• CXR

Pre-anesthesia consultation

What does this refer to

• Restrictive respiratory disease

• Interstitial Lung Disease

• Idiopathic Interstitial Pneumonia

Intrinsic lung disorders

What does this refer to

• Increased chest wall impedance

• Limited spacing

• Costovertebral disorders

• Congenital abnormality

• Traumatic abnormality

Extrinsic restrictive disorders

What does this refer to

• Increased intraabdominal pressure

• Central obesity

• Ascites

• Pregnancy

Related to Lung Dx

What does this refer to

• COPD

• Heart Failure

• OSA

• Metabolic

• Pulmonary HTN

• Factors

Post-operative pulmonary complication (POPC)

What does this refer to

• Hgb

• Albumin

• BUN

Metabolic (post-operative pulmonary complication)

Why is pulmonary HTN a concern of post-operative pulmonary complication (POPC)

Increase morbidity and mortality

What does this refer to

• Risk factors

• Surgery > 2 hour

• General anesthesia risk

Factors or Post-operative pulmonary complications (POPC)

What does this refer to

• Determines pulmonary complication (risk of pneumonia post op and risk of respiratory failure)

• For postoperative pulmonary complicaiton

• for patients undergoing surgery under general, neuraxial, or regional anesthesia.

ARISCAT Score

What does this refer to

• Monitored anesthesia care

• Airway management

• Selection of anesthetic agents

Intraoperative Management

What does this refer to

• Hypoxemia

• V/Q Mismatch

• Impaired Diffusion

• Decreased mixed venous oxygen content

Management of Intraoperative Complications

What does this refer to

Choice of Anesthetic technique

What does this refer to

• antiemetic requirements were higher in general anesthesia

Conscious sedation

What does this refer to

• Neuraxial anesthesia

Regional Anesthesia

What does this refer to

• Spinal anesthesia

• allow early home discharge

As clinicians, you will want to keep your patients from being in harm’s way and how can you do that without assessing the patient and the situation?

Thorough history and physical

What does this refer to

Management in the Post-Anesthesia Care Unit