Preoperative Evaluation and Fasting Guidelines

Questions and Answers

What is the primary goal of the preanesthetic evaluation?

To ensure that patients are fully sedated before surgery

To schedule surgery as quickly as possible

To identify and mitigate intra-operative risks (correct)

To provide immediate medical treatment prior to surgery

Which of the following is NOT a benefit of a Preanesthesia Assessment Clinic (PAC)?

Decreased patient anxiety

Improvement in patient education

Increased surgical cancellations (correct)

Decreased length of hospitalization after surgery

How does inadequate preoperative planning impact surgical procedures?

It leads to shorter surgical times and higher efficiency

It is associated with increased anesthetic complications (correct)

It guarantees optimized patient conditions

It promotes better communication among care providers

Which statement best describes a function of the preanesthetic evaluation?

To assess the patient's overall health status Signup and view all the answers

What is a primary goal of the preoperative evaluation and preparation of a patient?

To minimize peri-operative morbidity and mortality Signup and view all the answers

Which outcome is most likely associated with a well-conducted preanesthetic evaluation?

Decreased hospital stays post-surgery Signup and view all the answers

What might be a consequence of insufficient patient preparation before surgery?

Higher risk of anesthesia-related issues Signup and view all the answers

What does the preanesthesia assessment facilitate regarding patient management?

It allows effective communication of patient management issues Signup and view all the answers

Which factor contributes to an increased risk of aspiration during cesarean surgery?

Decreased tone of the lower esophageal sphincter Signup and view all the answers

What clinical sign is primarily indicative of aspiration pneumonitis?

Arterial hypoxemia Signup and view all the answers

What mechanism is commonly impaired in patients leading to delayed gastric emptying?

Lower esophageal sphincter relaxation Signup and view all the answers

Which condition is associated with a larger than normal residual gastric volume?

Intestinal obstruction Signup and view all the answers

What is the most common radiographic finding associated with aspiration?

Pulmonary edema Signup and view all the answers

Which pharmacological agent is aimed at increasing lower esophageal sphincter tone?

Atropine Signup and view all the answers

Which patient population is NOT considered at increased risk of aspiration?

Healthy young adults Signup and view all the answers

What role does progesterone play in aspiration risk during pregnancy?

Relaxes the gastroesophageal sphincter Signup and view all the answers

What intervention is NOT recommended for the prophylaxis of aspiration?

Routine use of histamine blockers Signup and view all the answers

What adjustment should be made to the head of bed for patients at risk of aspiration?

30-degree head down position Signup and view all the answers

What is the result of tobacco cessation lasting more than 8 weeks?

Improvement in pulmonary mechanics Signup and view all the answers

Which airway assessment tool is part of the LEMON mnemonic?

Obstruction evaluation Signup and view all the answers

What could indicate significant risk during anesthesia for a patient with ischemic heart disease?

Unstable angina or recent myocardial infarction Signup and view all the answers

What does a Mallampati classification of Class 3 indicate?

The uvula is not visible Signup and view all the answers

Which factor is most concerning when assessing a patient with a history of CHF before surgery?

Dyspnea and moist rales during examination Signup and view all the answers

What does an increased neck circumference suggest during pre-anesthesia assessment?

Higher likelihood of difficult intubation Signup and view all the answers

Which parameter is part of evaluating comorbidities impacting anesthesia?

Surgical procedure type Signup and view all the answers

What indicates a higher risk of intraoperative complications in a patient with hypertension?

Uncontrolled hypertension during preoperative assessment Signup and view all the answers

What is a significant risk for patients with long-standing obstructive sleep apnea if not monitored carefully?

Potential for laryngospasms Signup and view all the answers

Which of the following conditions is NOT an indicator for an elevated risk of significant blood loss during surgery?

Pregnancy Signup and view all the answers

What does the ASA classification system NOT take into account?

The patient's anesthesia risk Signup and view all the answers

What is the most reliable indicator of liver dysfunction?

Increased prothrombin time Signup and view all the answers

Which factor contributes to an increased requirement for pain management in sickle cell patients?

Reduced oxygen carrying capacity Signup and view all the answers

In which scenario is a pregnancy test considered mandatory prior to a surgical procedure?

If the procedure poses risks for the fetus Signup and view all the answers

What is a classic respiratory complication associated with extreme obesity?

Decreased functional residual capacity Signup and view all the answers

What condition is often associated with dysregulation of anesthesia administration in the elderly?

Hypoalbuminemia Signup and view all the answers

What is a critical side effect to communicate to a patient regarding regional anesthesia?

Prolonged numbness or weakness Signup and view all the answers

What is a common misconception regarding routine preoperative labs for fit and asymptomatic patients?

They are always recommended regardless of status Signup and view all the answers

What is the primary benefit of applying cricoid pressure during Rapid Sequence Induction (RSI)?

It seals the upper esophageal sphincter to minimize gastric content spillage. Signup and view all the answers

At what airway pressure range is gastric insufflation likely to occur in some patients during bag-mask ventilation?

15-25 cmH2O Signup and view all the answers

Which statement correctly describes the role of cricoid pressure during anesthesia induction?

It is used to press the esophagus against the cervical vertebrae, minimizing regurgitation. Signup and view all the answers

What is the recommended cricoid pressure range to effectively prevent regurgitation during RSI?

20-30 newtons (N) Signup and view all the answers

What should be avoided immediately following induction during Rapid Sequence Intubation if a failed intubation attempt occurs?

Bag-mask ventilation with sustained cricoid pressure. Signup and view all the answers

What is a primary risk associated with excessive cricoid pressure application?

Airway obstruction due to vocal cord closure. Signup and view all the answers

Why is it recommended to use the 'sniffing position' during intubation?

It opens the airway by aligning the oral and pharyngeal axes. Signup and view all the answers

Which of the following statements about ventilation pressures during bag-mask ventilation is accurate?

Low pressures below 15 cmH2O rarely cause gastric insufflation. Signup and view all the answers

Which medication is commonly used for sedation and hypnosis during RSI?

Propofol Signup and view all the answers

In what situation should a nasogastric tube be left in place during induction?

When there are concerns about increased intragastric pressure. Signup and view all the answers

What is the primary purpose of reviewing prior anesthetic records during the preanesthetic evaluation?

To identify any airway issues and previous anesthetic complications Signup and view all the answers

During the patient interview, which technique is recommended for gathering a patient's medical history?

Minimizing note taking to promote patient dialogue Signup and view all the answers

Which of the following factors should be included when assessing a patient's comorbidities?

Severity, treatment modalities, and limitations on activity Signup and view all the answers

In the context of review of systems, which symptom may suggest obstructive sleep apnea?

Daytime sleepiness and snoring Signup and view all the answers

What specific information should be obtained regarding the patient's drug history?

All medications, including herbal supplements and their effects Signup and view all the answers

What is the implication of having no previous surgery in relation to anesthesia?

No previous anesthesia experience may necessitate special considerations Signup and view all the answers

Which anesthetic complication should immediate family history particularly focus on during the evaluation?

Malignant hyperthermia and pseudocholinesterase deficiency Signup and view all the answers

When should herbal medicines be specifically monitored or discussed in a preanesthetic evaluation?

When they are known to cause excessive sedation or bleeding Signup and view all the answers

What condition has been linked to a significant portion of intraoperative anaphylactic reactions?

Latex sensitivity Signup and view all the answers

Which factor is critical for assessing the cardiovascular system in preanesthetic evaluations?

Severity and stability of pre-existing diseases Signup and view all the answers

What must be documented regarding a patient's allergies in preanesthetic evaluation?

A complete history of all allergic reactions, differentiating between side effects and true allergies Signup and view all the answers

When evaluating a patient's current problems and illness, what information is particularly important?

Current medications and any recent exacerbations of chronic conditions Signup and view all the answers

Which statement correctly describes the approach to pulmonary system evaluation during preanesthetic assessment?

Consider all respiratory symptoms, including frequency and triggers Signup and view all the answers

What is a key recommendation regarding medication management for insulin before surgery?

Reduce long-acting insulin doses by half and continue basal rates for pumps Signup and view all the answers

What should be the focus when educating a patient about the surgery process?

Ensuring the patient understands the procedure and addressing concerns to reduce anxiety Signup and view all the answers

Which preoperative medication is specifically indicated to decrease airway secretions?

Anticholinergic Signup and view all the answers

What classification of patients is most likely to develop pneumonia from aspiration?

ASA Class 3-4 Signup and view all the answers

What does an empty stomach indicate in terms of aspiration risk?

Low aspiration risk Signup and view all the answers

Which factor is NOT included when formulating an anesthetic plan?

Annual medical check-up history Signup and view all the answers

Which type of content in the stomach poses the highest aspiration risk?

Solid food Signup and view all the answers

What happens to the antrum of the stomach when thick fluid or solid food is present?

Heterogeneous and hyperechoic Signup and view all the answers

What is the correlation of the cross-sectional area (CSA) of the antrum to gastric volume?

Linear correlation Signup and view all the answers

In which scenario is the risk of aspiration LEAST likely increased?

Patients on antacids Signup and view all the answers

What is the primary consideration when assessing gastric ultrasound results with a large hiatal hernia?

Interpretation difficulty Signup and view all the answers

What increase in risk for aspiration is associated with ASA class IV or V patients?

Seven-fold increase Signup and view all the answers

What is a potential complication from chemical pneumonitis due to aspiration?

Mechanical obstruction Signup and view all the answers

How long is it typically recommended to fast before surgery to mitigate aspiration risk?

8 hours Signup and view all the answers

Which statement about patient cooperation is true during anesthetic planning?

High cooperation decreases aspiration risk Signup and view all the answers

Which of the following is MOST critical in determining the anesthetic plan with respect to airway management?

Planned surgical procedure Signup and view all the answers

Study Notes

Preanesthetic Evaluation

Clinical assessment that precedes anesthesia care for surgical and non-surgical procedures.
Aims to gather patient information and assess intra-operative risks.
Focus on risk identification and mitigation to optimize patient conditions and manage effectively.
Inadequate preoperative planning can lead to anesthetic complications.
Facilitates the formulation of an anesthetic plan.
Reduces surgical morbidity and costs associated with delays and cancellations.
Identifies patients that may benefit from specific medical treatments prior to surgery.
Important for informed consent and provision of psychological support to patients and families.

Preanesthesia Assessment Clinic (PAC)

Cost-effective patient preparation venue.
Aims to register patients, obtain medical history, conduct physical exams, and provide patient education.
Reduces anxiety and overall costs while improving operational efficiency.
Enable outpatient surgery and pre-surgery optimization.

Goals of Preoperative Evaluation

Optimize patient care and satisfaction while minimizing mortality and morbidity.
Prevent unnecessary surgical delays and cancellations.
Assess overall health status and determine necessary preoperative investigations.
Facilitate effective communication among care providers.
Educate patients on surgery and anesthesia to alleviate anxiety.

Content of Preanesthetic Evaluation

Chart Review

A thorough history and current medical record assessment are crucial.
Prior anesthetic records must be examined for airway issues and other concerns.

Patient Interview

Establish routine systems-based inquiries using open-ended questions.
Confirm medical history and evaluate the patient's social situation regarding surgical support.
Important to educate on risk management and obtain informed consent.

Medical History Assessment

Focus on critical elements like airway, cardiac, pulmonary, renal, endocrine, and gastrointestinal conditions, among others.
Identify undiagnosed medical conditions that could affect anesthesia.

Surgical and Anesthetic History

Review past surgical experiences and adverse reactions to anesthesia.
Family history of anesthesia complications should be specifically queried.

Cardiovascular System Evaluation

Must assess pre-existing conditions, including severity and stability of diseases.
History of myocardial infarction or unstable angina indicates high intraoperative risk.

Drug History

Document all medications including herbal supplements and allergies.
Caution required for specific medications like MAOIs, ACE/ARBs, and certain herbals which may pose risks.

Assess substance use, specifically tobacco and alcohol, which can influence surgical outcomes.
Cessation of tobacco significantly reduces peri-operative risks.

Directed Preanesthesia Exam

Physical examination complements history to detect unnoticed issues.
Airway evaluation is critical for all patients.

Alarm Features in Comorbid Conditions

Look for high-risk factors including uncontrolled hypertension, heart failure, and significant respiratory issues.
Cardiovascular conditions such as ischemic heart disease and arrhythmias demand thorough evaluation.

Preoperative Tests

Routine labs are not recommended for asymptomatic patients; focus on tailored tests based on historical findings.
Pregnancy testing is based on clinical indications with patient rights to refuse.

ASA Classification

American Society of Anesthesiologists classification reflects preoperative status without estimating anesthesia risk.
Useful for billing but may not always be accurately classified.

Informed consent involves detailed communication with the patient about the diagnosis, treatment risks, alternatives, and prognosis.
Common anesthesia risks include sore throat, nausea, drowsiness, and potential complications associated with both general and regional anesthesia.### Premedication for Anesthesia
Benzodiazepines: Administer midazolam intravenously for adults and orally for children.
Anticholinergics: Given pre-operatively to reduce airway secretions.
Opioids: Used as indicated, depending on patient needs.
Anti-emetics: Scopolamine, steroids, and H2 blockers are given for patients with nausea or aspiration risks.
Steroid coverage: Administer stress dose steroids when necessary.
Antibiotics: Consider based on patient history.

Anesthetic Plan Considerations

Surgical procedure: Tailor anesthetic based on planned intervention.
Coexisting conditions: Take into account any health issues.
Patient positioning: Risks associated with different surgical positions.
Aspiration risk: Assess based on patient history and procedure type.
Patient factors: Age, cooperation level, and airway management strategies should be evaluated.
Coagulation status: Important for overall safety.
Anesthetic history: Consider both personal and familial history with anesthesia.
Patient preference: Incorporate patient choices into the anesthetic plan.

Fasting Guidelines

Aspiration risk: Pulmonary aspiration can result in serious complications, despite being relatively rare.
Incidence: Occurs in approximately 1 in 35,000 anesthetics; more common in ASA Class 3-4 patients.
Fasting duration: Recommended fasting for heavy/fatty meals is at least 8 hours.

Gastric Ultrasound for Aspiration Risk

Identification of stomach contents: Determines aspiration risk (empty, clear fluid, thick fluid/solid).
Assessment outcomes: Results indicate whether to delay, cancel, or proceed with surgery prophylactically.
Volume measurement: Useful to identify fasting status (low vs. high volume can indicate fasting compliance).
Visualization techniques: Various appearances of the gastric antrum based on contents (e.g., empty, solid, clear fluid).

Aspiration Mechanics and Risk

Aspiration components: Involves movement from stomach to pharynx and then to lungs, potentially causing injury.
Symptoms: Can be silent or symptomatic with cough, wheezing, or pneumonia development.
Aspirate characteristics: Type (contaminated, acidic, particulate) and volume play a role in risk severity.
Risk factors: Include emergency surgery, elevated ASA class, obesity, and gastric stasis.

Clinical Signs and Management of Aspiration

Signs of aspiration pneumonitis: Arterial hypoxemia, tachypnea, dyspnea, wheezing, and cyanosis.
Radiographic findings: Infiltrates and pulmonary edema in dependent regions.
Management strategies: Adjust head position, deep suctioning if necessary, oxygen administration, and potential intubation if needed.

Rapid Sequence Intubation (RSI)

RSI procedure: Emphasizes minimal pressure for ventilation and use of cricoid pressure to reduce aspiration risk during induction.
Medications used: Various sedative and muscle relaxant options with specific onset and duration profiles.
Cricoid pressure: Applied to occlude the esophagus and prevent regurgitation; specific techniques and pressures are critical for effectiveness.

Patient Post-Operative Instructions

NPO status: Clear instructions regarding fasting and resumption of normal diet following surgery.
Medications: Guidelines for resuming or altering medication regimens post-anesthesia.
Tobacco use: Considerations for habitual users regarding postoperative recovery and healing.

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Description

This quiz covers the essential aspects of preanesthetic evaluation, including clinical assessment processes prior to anesthesia delivery. It focuses on gathering important medical history and understanding intra-operative risks associated with patients. Participants will learn about optimizing patient conditions and the importance of identifying risks before surgery.