Perioperative Patient Assessment Flashcards

A patient taking clopidogrel for a coronary stent placed 4 months ago requires urgent hip fracture surgery. The recommended management is:

Answer: Proceed with surgery; withholding antiplatelet therapy risks in-stent thrombosis

For urgent surgery, the risk of delaying outweighs the bleeding risk; proceeding is recommended, and neuraxial anesthesia would be contraindicated per ASRA guidelines if clopidogrel was recently taken.

The normal adult functional residual capacity (FRC) is significantly reduced by which factor that increases aspiration and desaturation risk?

Answer: Supine positioning and induction of general anesthesia

Supine position and induction of general anesthesia reduce FRC by 20–30% due to cephalad diaphragmatic displacement and loss of awake respiratory muscle tone, decreasing the oxygen reservoir and safe apnea time.

Which preoperative finding on ECG most significantly increases perioperative risk for non-cardiac surgery?

Answer: Left bundle branch block (new or unknown onset)

New or unknown LBBB can mask ST changes of ischemia, may indicate severe underlying cardiac disease (cardiomyopathy, CAD), and requires further cardiac evaluation before elective surgery.

In pediatric patients, which calculation is used to estimate blood volume for transfusion planning?

Answer: Estimated blood volume = weight (kg) × 70–80 mL/kg for term neonates

Term neonates have approximately 80–90 mL/kg blood volume, older infants 70–80 mL/kg, and children 70 mL/kg; this estimate guides allowable blood loss calculations and transfusion thresholds.

A patient's preoperative HbA1c of 10.5% suggests what and has what implication for elective surgery?

Answer: Poorly controlled diabetes associated with increased risk of surgical site infection and cardiovascular complications; consider optimizing glycemic control

HbA1c >8% reflects chronic hyperglycemia and is associated with impaired wound healing, infection, and perioperative cardiovascular events; HbA1c >9–10% often warrants preoperative optimization for elective cases.

Chronic kidney disease (CrCl <30 mL/min) affects anesthetic management primarily because it impairs elimination of what drugs?

Answer: Renally cleared drugs including morphine-6-glucuronide, neostigmine, and pancuronium

Renal impairment accumulates renally-cleared drugs and active metabolites; morphine-6-glucuronide (active, sedating), neostigmine, and steroidal NMBDs (pancuronium) are especially problematic.