Perioperative Risk Optimization ppt

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Questions and Answers

Why is estimating risk particularly critical in surgical procedures?

It eliminates the need for patient consent.

It indicates the likelihood of successful surgery.

It helps in enhancing the patient's recovery time.

It helps providers, surgeons, and patients weigh risks and benefits including potential mortality. (correct)

What is the primary focus of pre-operative screening for intermediate and high-risk procedures?

To ensure that the surgery is scheduled as soon as possible.

To provide comprehensive routine testing regardless of patient health.

To estimate perioperative risk for complications and minimize risk while avoiding surgery delays. (correct)

To reduce the cost of the procedure.

Which of the following procedures is classified as high risk?

Dental extractions.

Major thoracic surgery. (correct)

Ophthalmologic procedures.

Elective orthopedic surgery.

What should be included in the assessment for low-risk procedures?

Thorough medical, bleeding, medication, and anesthetic history. Signup and view all the answers

What is one possible outcome of not properly screening intermediate and high-risk patients?

Increased likelihood of perioperative complications. Signup and view all the answers

What types of surgeries are considered low risk?

Endoscopic and dental surgeries. Signup and view all the answers

Which patient characteristic is crucial for risk stratification in pre-operative assessment?

Detailed medical history including cardiopulmonary health. Signup and view all the answers

What does the term 'risk stratification' refer to in the context of surgeries?

Determining the level of risk associated with different surgical procedures for individual patients. Signup and view all the answers

What is the significance of establishing a patient's baseline health status before surgery?

To assess if any changes occurred during the procedure Signup and view all the answers

Which condition is most closely associated with the risk of malignant hyperthermia during anesthesia?

Family history of adverse reactions to anesthesia Signup and view all the answers

What pre-operative laboratory test is generally required for all women of child-bearing age?

Pregnancy test Signup and view all the answers

What does a patient's ability to perform ≥ 4 METs indicate regarding surgical risk?

Low risk for complications, especially cardiovascular Signup and view all the answers

Which of the following cardiac conditions would NOT typically cause a delay or cancellation of surgery?

Controlled hypertension Signup and view all the answers

What is the primary role of Dantrolene in the management of malignant hyperthermia?

Counteract muscle rigidity Signup and view all the answers

Which of the following factors does NOT contribute to determining a patient's ASA status?

Age of the patient Signup and view all the answers

What is the recommended approach for patients who are already taking beta blockers prior to surgery?

Continue current beta blockers without interruption Signup and view all the answers

Which patient characteristic is considered a minor predictor of complications?

Advanced age over 70 Signup and view all the answers

What does the acronym RCRI stand for in the context of assessing cardiac risk?

Revised Cardiac Risk Index Signup and view all the answers

What is the significance of assessing a patient's exercise capacity expressed in METs?

To evaluate potential surgical and anesthesia risk Signup and view all the answers

Which condition would likely necessitate non-invasive cardiac stress testing prior to surgery?

Known coronary artery disease with poor functional status Signup and view all the answers

Which surgical risk factor is considered when evaluating a patient's need for pre-operative assessment?

Type of surgical procedure being performed Signup and view all the answers

Why is a resting 12-lead EKG indicated for asymptomatic patients over certain age thresholds?

To rule out silent ischemia or other cardiac issues Signup and view all the answers

What is the significance of assessing pulmonary risk factors such as age > 60 and tobacco abuse in surgical patients?

They help identify patients who may experience postoperative pulmonary complications. Signup and view all the answers

What is advised regarding anticoagulant management for a patient with a mechanical heart valve undergoing high-risk surgery?

Consult cardiology and adjust anticoagulation strategy appropriately. Signup and view all the answers

Why is it important to perform a bleeding history evaluation before surgery?

To identify potential clotting disorders and ensure proper surgical management. Signup and view all the answers

What is a recognized strategy to mitigate the risk of postoperative venous thromboembolism (VTE)?

Administer a single dose of heparin as prophylaxis before surgery. Signup and view all the answers

How does chronic adrenal suppression influence perioperative management?

It requires stress doses of steroids to prevent an Addisonian crisis. Signup and view all the answers

Which pre-operative management strategy is NOT recommended for patients with chronic kidney disease (CKD)?

Ensure intravascular volume depletion. Signup and view all the answers

What is the recommended action regarding pre-operative glucose management?

Encourage glucose control, especially for those at risk of elevated levels. Signup and view all the answers

What pulmonary complications are significant concerns in surgical patients?

Postoperative respiratory failure and pneumonia. Signup and view all the answers

What should be considered for patients who present with new anemia before surgery?

It should be thoroughly evaluated as it can increase morbidity and mortality. Signup and view all the answers

Which of the following factors would NOT contribute to an increased risk of postoperative pulmonary complications?

Female gender. Signup and view all the answers

What is the primary purpose of using pre-operative antibiotics?

To reduce the risk of surgical site infections in specific types of procedures. Signup and view all the answers

How is the risk of postoperative anemia managed?

Assessing hemoglobin levels and evaluating the need for transfusion. Signup and view all the answers

Which patient demographic is likely to require special attention related to renal risk during surgery?

Patients with chronic kidney disease (CKD) requiring dialysis. Signup and view all the answers

What role does screening for sleep apnea play in pre-operative assessments?

It identifies patients at risk of complications during anesthesia. Signup and view all the answers

Study Notes

Importance of Estimating Perioperative Risk

Providers, surgeons, and patients assess risks and benefits for interventions, especially in surgeries and anesthesia.
A patient categorized as "high risk" indicates a significant chance of death from the procedure.
Risk discussions are critical when considering elective surgeries and preparing families for potential outcomes.

Risk Stratification by Procedure Type

Lower Risk Procedures: Endoscopic, ophthalmologic, dental, skin/superficial procedures.
Intermediate Risk Procedures: Non-vascular abdominal, infra-inguinal vascular, carotid/head/neck, orthopedic, prostate/urologic surgeries.
Higher Risk Procedures: Emergent surgeries, major thoracic, aortic, or supra-inguinal vascular surgeries, those involving significant fluid shifts or blood loss.

Preoperative Evaluation and Screening

Low Risk: Comprehensive history typically sufficient; routine testing often non-beneficial.
Intermediate/High Risk: Requires additional screenings, focusing on cardiopulmonary health.
Detailed questionnaires assess medical history, including cardiopulmonary, renal, hepatobiliary, metabolic/endocrine, and CNS issues.
Anesthetic history and bleeding history are crucial for preparatory assessments.

Preoperative Data Collection

Resting 12-lead EKG: Necessary for asymptomatic women over 50, men over 45, or those with known cardiac history.
Pre-op CXR generally not useful in asymptomatic patients unless respiratory symptoms are present.
Necessary labs may include BMP, H&H, coags, and pregnancy tests for child-bearing women.

Surgical and Anesthetic Risk Factors

Low Risk Indicators: Age under 50, absence of significant medical issues.
Anesthetic Risk: Overall risk low but varies with procedural type and patient conditions. ASA Physical Status Scale helps predict morbidity/mortality.
Exercise Capacity Assessment: Measured in METs; able to perform ≥ 4 METs indicates low CV complication risk.

Malignant Hyperthermia

Rare but severe reaction to anesthetics, typically genetic; family history screening is vital.
Initial symptoms include hypercapnia and muscle rigidity; treatment involves Dantrolene for muscle relaxation and hyperkalemia correction.

Airway Evaluation

Assess cervical spine mobility, uvula, thyromental distance, and dental status, as higher Mallampati scores indicate increased difficulty.

Cardiac Risk Factors

Major adverse coronary events risk highlighted by Revised Cardiac Risk Index and 2014 ACC/AHA guidelines.
Conditions possibly delaying surgery include unstable angina, heart failure, and severe arrhythmias.
Goldman’s Criteria: Factors indicating >5% perioperative cardiac event risk include ischemic heart disease, heart failure history, and substance use history.

Pulmonary Risk Management

Postoperative pulmonary complications include pneumonia and respiratory failure, significantly increasing mortality and hospital stay.
Smoking cessation advised four weeks prior; sleep apnea screening recommended.

Hematologic Risk Considerations

New anemia should be evaluated preoperatively; understanding bleeding history and medication use is crucial.
Anticoagulation management depends on the risk of thromboembolism versus surgery type.

Renal Risk Management

Acute kidney injury can worsen outcomes; maintaining fluid levels and pre-op dialysis for CKD patients enhances safety.
High-risk patients should avoid nephrotoxins pre-surgery.

Endocrine Risks

Hyperglycemia before surgery leads to various complications; managing glucose levels pre- and post-operatively is critical.
Adrenal insufficiency poses risks; may require steroid stress dosing during surgery.

Infection Prevention Strategies

Surgical site infection prevention relies on excellent perioperative glucose control and thorough skin preparation protocols.
Preoperative antibiotics prescribed based on surgical type, ensuring prophylactic measures are specified for clean, clean-contaminated, or dirty surgeries.

Comprehensive Risk Determination

Understanding perioperative risk encompasses anesthetic risk, surgery-specific risk, and patient variables.
Recognizing patients needing additional evaluation is essential for effective preoperative management, aiding in high-quality surgical outcomes.

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Description

Explore the significance of estimating perioperative risk for surgical procedures. This quiz covers risk stratification by procedure type and emphasizes the importance of preoperative evaluations. Understanding these factors is vital for both providers and patients in making informed decisions for elective surgeries.