Perioperative Assessment Flashcards

A 72-year-old patient is scheduled for elective hip replacement. Which preoperative factor MOST increases their perioperative cardiac risk?

Answer: History of congestive heart failure with reduced ejection fraction

Congestive heart failure with reduced ejection fraction is a major independent predictor of perioperative cardiac morbidity and mortality per the Revised Cardiac Risk Index.

A pediatric patient (age 4) is scheduled for an appendectomy. Compared to adults, the first assistant should expect which perioperative difference?

Answer: Higher surface area-to-volume ratio increasing heat loss risk

Children have a high surface area-to-volume ratio, making them significantly more susceptible to intraoperative hypothermia than adults.

A pregnant patient at 24 weeks gestation requires an emergency appendectomy. What is the MOST critical positioning consideration?

Answer: Left lateral uterine displacement to prevent aortocaval compression

The gravid uterus can compress the aorta and inferior vena cava in the supine position; left lateral tilt or displacement prevents supine hypotensive syndrome.

A patient with Type 1 diabetes has a preoperative blood glucose of 280 mg/dL. The first assistant should understand that proceeding without correction increases the risk of:

Answer: Impaired wound healing and increased infection susceptibility

Hyperglycemia impairs neutrophil function and tissue oxygenation, increasing the risk of surgical site infection and delayed wound healing.

During preoperative assessment of an elderly patient, the first assistant notes the patient cannot climb one flight of stairs without dyspnea. This represents approximately how many metabolic equivalents (METs)?

Answer: Less than 4 METs

Inability to climb one flight of stairs or walk on level ground without symptoms indicates functional capacity below 4 METs, which is associated with increased perioperative cardiac risk.

A patient with obstructive sleep apnea (OSA) is assessed preoperatively. Which perioperative precaution is MOST important for the first assistant to communicate to the team?

Answer: Plan for close postoperative respiratory monitoring and possible CPAP

OSA patients are at high risk for postoperative respiratory depression and airway obstruction, requiring close monitoring and continuation of CPAP therapy.

When assessing a patient on chronic corticosteroid therapy (prednisone 20 mg/day for 6 months) scheduled for major surgery, the primary perioperative concern is:

Answer: Adrenal suppression and risk of adrenal crisis under surgical stress

Chronic exogenous steroid use suppresses the HPA axis, impairing the adrenal stress response; these patients require perioperative stress-dose steroids to prevent adrenal crisis.