Questions and Answers
Why is estimating risk particularly critical in surgical procedures?
What is the primary focus of pre-operative screening for intermediate and high-risk procedures?
Which of the following procedures is classified as high risk?
What should be included in the assessment for low-risk procedures?
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What is one possible outcome of not properly screening intermediate and high-risk patients?
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What types of surgeries are considered low risk?
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Which patient characteristic is crucial for risk stratification in pre-operative assessment?
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What does the term 'risk stratification' refer to in the context of surgeries?
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What is the significance of establishing a patient's baseline health status before surgery?
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Which condition is most closely associated with the risk of malignant hyperthermia during anesthesia?
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What pre-operative laboratory test is generally required for all women of child-bearing age?
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What does a patient's ability to perform ≥ 4 METs indicate regarding surgical risk?
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Which of the following cardiac conditions would NOT typically cause a delay or cancellation of surgery?
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What is the primary role of Dantrolene in the management of malignant hyperthermia?
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Which of the following factors does NOT contribute to determining a patient's ASA status?
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What is the recommended approach for patients who are already taking beta blockers prior to surgery?
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Which patient characteristic is considered a minor predictor of complications?
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What does the acronym RCRI stand for in the context of assessing cardiac risk?
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What is the significance of assessing a patient's exercise capacity expressed in METs?
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Which condition would likely necessitate non-invasive cardiac stress testing prior to surgery?
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Which surgical risk factor is considered when evaluating a patient's need for pre-operative assessment?
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Why is a resting 12-lead EKG indicated for asymptomatic patients over certain age thresholds?
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What is the significance of assessing pulmonary risk factors such as age > 60 and tobacco abuse in surgical patients?
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What is advised regarding anticoagulant management for a patient with a mechanical heart valve undergoing high-risk surgery?
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Why is it important to perform a bleeding history evaluation before surgery?
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What is a recognized strategy to mitigate the risk of postoperative venous thromboembolism (VTE)?
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How does chronic adrenal suppression influence perioperative management?
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Which pre-operative management strategy is NOT recommended for patients with chronic kidney disease (CKD)?
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What is the recommended action regarding pre-operative glucose management?
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What pulmonary complications are significant concerns in surgical patients?
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What should be considered for patients who present with new anemia before surgery?
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Which of the following factors would NOT contribute to an increased risk of postoperative pulmonary complications?
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What is the primary purpose of using pre-operative antibiotics?
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How is the risk of postoperative anemia managed?
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Which patient demographic is likely to require special attention related to renal risk during surgery?
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What role does screening for sleep apnea play in pre-operative assessments?
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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.