Perioperative Patient Assessment Flashcards

A patient with severe aortic stenosis presents for hip replacement. Which hemodynamic goal is most important intraoperatively?

Answer: Maintain normal sinus rhythm and avoid tachycardia and hypotension

Severe AS requires a fixed cardiac output; tachycardia reduces diastolic filling time, hypotension removes coronary perfusion pressure, and arrhythmias can cause rapid decompensation.

Which condition warrants postponing elective surgery for preoperative optimization?

Answer: Uncontrolled hypertension with BP >180/110 mmHg

Severe uncontrolled hypertension (>180/110) is associated with increased perioperative cardiovascular complications and should be optimized when surgery permits; mild-to-moderate HTN generally does not require postponement.

A patient with GERD and obesity presenting for laparoscopic surgery is considered at risk for pulmonary aspiration; the most effective pharmacological prophylaxis includes:

Answer: H2 blocker or proton pump inhibitor plus metoclopramide preoperatively

Reducing gastric acid production (H2 blocker/PPI) combined with metoclopramide (to accelerate gastric emptying) decreases both gastric volume and acidity, reducing aspiration risk and severity.

The Apfel score is used preoperatively to predict risk of what postoperative complication?

Answer: Postoperative nausea and vomiting (PONV)

The Apfel simplified risk score uses four factors (female sex, non-smoking, history of PONV/motion sickness, postoperative opioid use) to predict PONV risk and guide prophylactic antiemetic strategy.

Obstructive sleep apnea (OSA) increases perioperative risk primarily due to increased sensitivity to what?

Answer: Opioids and sedatives causing upper airway obstruction and hypoxia

OSA patients have baseline hypoxemia risk and exaggerated sensitivity to opioids and sedatives, which further depress pharyngeal muscle tone and respiratory drive, increasing postoperative airway obstruction risk.

Which preoperative cardiac test is indicated when a patient with poor functional capacity (<4 METs) is scheduled for high-risk surgery and the result would change management?

Answer: Pharmacologic stress testing (dobutamine stress echo or nuclear stress test)

Patients who cannot achieve 4 METs and face high-risk surgery may benefit from pharmacologic stress testing to identify significant coronary artery disease that would alter perioperative management.