Preoperative Evaluation Importance

18 Questions

Why is preoperative evaluation considered vital?

To recognize patient comorbidities

What is a prime aim of obtaining anesthesia consent during preanesthetic evaluation?

Motivating patients to stop smoking

What does the ASA classification focus on in predicting perioperative morbidity and mortality?

Patient-based morbidity

How are healthy pregnant patients in labor classified according to ASA classification?

ASA II

What additional targets are included in a preanesthetic evaluation besides the goals listed?

Educating patients about anesthesia

How does preoperative interaction help patients during the evaluation process?

Explains risks and procedures to the patient

According to ASA guidelines, how long should a patient wait before proceeding to surgery after being NPO?

4 hours

For a 45-year-old patient with a history of severe anesthesia reaction in a family member, which drug should be avoided for general anesthesia?

Ketamine

After a myocardial infarction, how long should elective surgery be postponed for?

30 days

What is the most significant risk factor for developing pulmonary complications post-surgery?

Smoking

What is the maximum international normalized ratio (INR) allowed before proceeding with elective surgery?

1.2

For a 73-year-old patient undergoing laparoscopic cholecystectomy with residual weakness from a stroke, which site should be used to monitor muscle twitches for neuromuscular blockade?

Right ulnar nerve–innervated muscles

What is the recommended INR level on the day of surgery to perform a surgical procedure safely?

1.4 or less

Why is it important to rule out left-atrial clots before initiating rate/rhythm control in patients potentially having atrial fibrillation for more than 48 hours?

To prevent embolic consequences

How long should elective surgery be avoided after a bare-metallic stent placement?

4 weeks

What does ASA III classification indicate in a patient preoperatively?

Severe systemic disease with constant life threat

Why is it advised to delay elective laparoscopic surgery after CABG surgery?

To give time for balloon dilatation

In what scenario should warfarin medication be stopped prior to surgery?

At least 5 days before surgery

Study Notes

Preoperative Evaluation

Preoperative evaluation includes a battery of tests, adding to the total perioperative costs.
It is vital to recognize patient comorbidities, which can worsen perioperatively and cause increased patient morbidity.
Preoperative evaluation lowers indirect costs that may be incurred to treat the worsening aliment postoperatively.

Goals of Preanesthetic Evaluation

Educating patients and families about anesthesia and the anesthesiologist's role.
Obtaining informed consent.
Motivating patients to stop smoking and lose weight, or commit to other preventive care.
Explaining the risks and procedure to lower patient anxiety.

ASA Classification

ASA classification only includes patient-based morbidity, not the type of surgery.
Healthy pregnant patients in labor are classified as an ASA II.
Patients with controlled diabetes or essential hypertension are still classified as an ASA II.

Preoperative Preparation

Elective surgery should be postponed after a myocardial infarction for at least 6 months.
The maximum international normalized ratio (INR) before proceeding for elective surgery should be 1.4 or less.
Warfarin should be stopped at least 5 days prior to surgery.
Before any rate/rhythm control in patients likely to have AF for more than 48 hours, left-atrial clots must be ruled out.

Patient-Specific Considerations

Patients with a history of reaction to anesthesia should avoid certain drugs during general anesthesia.
A patient with residual weakness on the right arm and leg following a stroke should be monitored for neuromuscular blockade on the left ulnar nerve.
Hemodynamically unstable patients secondary to perforation peritonitis may require surgical correction to improve their chances of survival.

Explore the significance of preoperative evaluation in recognizing patient comorbidities, lowering indirect costs, and reducing patient morbidity. Understand how preoperative evaluation can help in decreasing postoperative complications and alleviating patient anxiety.

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