General Surgery Board Review Perioperative Care & Complications Flashcards

Which ASA physical status classification is assigned to a patient with severe systemic disease that is a constant threat to life?

Answer: ASA IV

ASA IV denotes a patient with a severe systemic disease that is a constant threat to life, such as recent MI, CVA, TIA, or ongoing cardiac ischemia.

A patient on warfarin for atrial fibrillation requires elective colon resection. What is the standard perioperative anticoagulation strategy for high-thromboembolic-risk patients?

Answer: Stop warfarin 5 days before and bridge with therapeutic heparin

High-risk patients (e.g., mechanical mitral valve, high-risk AF) should stop warfarin 5 days preoperatively and receive bridging therapy with LMWH or UFH until surgery.

Per ASA guidelines, what is the minimum fasting time for clear liquids before elective surgery in healthy adults?

Answer: 2 hours

The ASA recommends a minimum 2-hour fast for clear liquids (including water, clear juices, carbonated beverages, and black coffee) before elective procedures.

Antibiotic prophylaxis for colorectal surgery should target which organisms?

Answer: Both gram-negative aerobes and anaerobes

Colorectal surgery prophylaxis must cover both gram-negative aerobes and anaerobes (e.g., cefazolin + metronidazole, or cefoxitin alone) due to the mixed flora of the colon.

Surgical antibiotic prophylaxis with cefazolin should be administered at what time relative to skin incision for optimal tissue levels?

Answer: Within 60 minutes before incision

Cefazolin should be administered within 60 minutes before skin incision (30–60 minutes recommended) to ensure adequate tissue concentrations at the time of incision.

The Revised Cardiac Risk Index (RCRI) includes all of the following EXCEPT:

Answer: Uncontrolled hypertension

The six RCRI factors are: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent diabetes, and creatinine >2.0 mg/dL — uncontrolled hypertension is not included.