Perioperative Patient Assessment Flashcards

The ASA Physical Status Classification System assigns ASA III to a patient who has what?

Answer: Severe systemic disease with functional limitation but not incapacitating

ASA III indicates severe systemic disease that limits activity but is not incapacitating; examples include poorly controlled DM, COPD, morbid obesity (BMI >40), and symptomatic CHF.

A patient with a history of recent myocardial infarction (within 60 days) presenting for elective non-cardiac surgery should ideally have surgery:

Answer: Postponed at least 60 days after MI unless the surgery is truly urgent

ACC/AHA guidelines recommend delaying elective non-cardiac surgery for at least 60 days after MI to allow myocardial healing and reduce perioperative cardiac morbidity.

The Revised Cardiac Risk Index (RCRI) includes which of the following as a risk factor?

Answer: History of ischemic heart disease, heart failure, or cerebrovascular disease, insulin-dependent diabetes, preoperative creatinine >2.0, and high-risk surgery

The 6-factor RCRI (Lee Index) predicts perioperative major adverse cardiac events using: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent DM, and Cr >2.0 mg/dL.

Which preoperative lab is most indicated before major elective surgery in a patient on warfarin?

Answer: Prothrombin time/INR

INR directly measures the anticoagulation effect of warfarin and determines whether adequate reversal has been achieved before proceeding with surgery.

In the preoperative airway assessment, which physical finding is most predictive of difficult bag-mask ventilation?

Answer: Beard, obesity (BMI >26), lack of teeth, age >55, and history of snoring (BONES mnemonic)

The BONES factors (Beard, Obesity, No teeth, Elderly, Snoring/OSA) identify patients likely to be difficult to ventilate with a mask, which is a separate assessment from difficult intubation.

According to current ASA fasting guidelines, clear liquids may be consumed up to how many hours before elective anesthesia in adults?

Answer: 2 hours

ASA guidelines permit clear liquids (water, fruit juice without pulp, carbonated beverages, tea, black coffee) up to 2 hours before elective procedures with general, regional, or monitored anesthesia care.