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APEX: intra op fluid therapy and ERAS Flashcards | StudBud
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APEX: intra op fluid therapy and ERAS
APEX: intra op fluid therapy and ERAS
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1
using the historical approach, what is the maintenance IVF rate for a 16 kg pt?
52 mL/hr
50 mL/hr
42 mL/hr
46 mL/hr
2
select the true statement(s)
fasting has large influence on intravascular fluid volume
"third spacing" losses are insignificant
patients can drink clear fluids up to two hours before surgery
we are likely giving too much fluid with historical approach
preop fasting causes dehydration
patients can drink clear fluids up to one hours before surgery
3
Historical fluid management strategies
calculation for replacing blood loss
4:2:1 rule
calculation for replacing "third space" losses
determining fluid deficity
4
key preop components of ERAS that is under control of anesthesia provider
abx prophylaxis
fasting/avoidance of premedication
fluid and carb loading
no/selective use of bowel prep
preadmission counseling
thromboprophylaxis
5
identify components of the enhanced recovery after surgery program believed to improve post surgical outcomes (select 2)
carb drink two hours before surgery
isoflurane instead of desflurane
avoidance of premedication
insertion of NGT
6
when the patient resides on the lower portion of the starling curve they are on the
right of curve
plateau
left of curve
slope
middle of curve
overshoot
7
select the true statement(s)
ADH release during sx causes pt to retaun fluid for days to weeks
urine output is an unreliable measure of lfuid status
post induction hypotension should be corrected with fluid
blood loss should always be replaced in a 3:1 or 1:1 ratio
HR, MAP, and CVP are the most reliable monitors of fluid baance
fluid replacement shoyld be guided by measures of fluid responsiveness
8
patient has preload independence when they are on the _____ of the starling curve
plateau
slope
overshoot
9
using the historical approach, what is the maintenance IVF rate for a 110 kg pt?
110 mL/hr
90 mL/hr
130 mL/hr
150 mL/hr
10
overshooting the patient on the starling curve:
decreases SVR
impairs myocardial performance
puts pt at risk for pulm edema
puts pt at risk for CHF
Increases SVR
increases CO
11
calculation for replacing "third space" losses:
severe trauma: 6-8 ml/kg/hour
severe trauma: 2-4 ml/kg/hr
severe trauma: 4-6 ml/kg/hr
example: major abdominal surgery
severe trauma: 1-2 ml/kg/hr
example: major orthopedic
12
calculation for replacing "third space" losses:
minimal trauma: none
example: major non abdominal surgery
minimal trauma: 1-2 ml/kg/hr
minimal trauma: 2-4 ml/kg/hr
example: inguinal hernia repair
minimal trauma: 4-6 ml/kg/hr
13
Which are of the Starling curve BEST correlates with preload dependence
unable to determine
ascending limb
descending limb
plateau
14
4:2:1 rule
1 ml/kg/hr for each subsequent kg of body weight
2ml/lk/hr for second 10lb of body weight
for adult: you can use body weight in kg + 40 mL
2ml/kg/hr for second 10kg of body weight
4ml/lb/hr for first 10lb of body weight
4ml/kg/hr for first 10kg of body weight
15
Calc for replacing blood loss
colloid 3:1
blood 3:1
blood 1:1
colloid 1:1
crystalloid 1:1
crystalloid 3:1
16
if the patient is on the slope, then:
patient is afterload dependent
patient is preload dependent
additional fluid increases sarcomere stretch
patient should be volume responsive
additional fluid does not increase sarcomere stretch
volume will impair myocardial performance
17
calculation for replacing "third space" losses:
example: lap chole
very minimal trauma: 1-2 ml/kg/hr
very minimal trauma: 4-6 ml/kg/hr
very minimal trauma: 2-4 ml/kg/hr
very minimal trauma: none
example: orofacial surgery
18
select the ERAS standarized approach components
minimize impact of fluid shifts
attenuate physiologic changes that accompany surgical trauma
improve post op pain
only used for colorectal surgeries
maximize nutritional impact of healing
impove pt education and compliance
19
calculation for replacing "third space" losses is dependent on
weight
type of surgery
degree of trauma
comorbidities
age
20
estimated fluid deficit is determined by
calculated hourly maintenance
type of surgery
hours fasted
weight
21
calculation for replacing "third space" losses:
moderate trauma: 4-6 ml/kg/hr
moderate trauma: 2-4 ml/kg/hr
example: major abdominal surgery
moderate trauma: 6-8 ml/kg/hour
example: major non abdominal surgery
moderate trauma: 1-2 ml/kg/hr
22
estimated fluid deficit:
calculated hourly maintenance + fasted hours
calculated hourly maintenance/ fasted hours
calculated hourly maintenance x fasted hours
calculated hourly maintenance - fasted hours
23
inadequate circulating volume
impairs 02 delivery d/t congestion
hypovolemia/hemoconcentration
increased PONV
reduces oxygen delivery/ myocardial ischemia
reduces CO/decreases organ perfusion
renal impairment
24
key postop components of ERAS that is under control of anesthesia provider
early removal of urinary cath
judicious fluid administration
post op counseling and follow up
opioid-sparing analgesia
early ambulation/encouraging gut motility
mid-throacic epidural anesthesia
25
too much circulating volume
impaired glycocalyx/ impaired wound healing (increased risk of infection)
increased risk for VAP
reduces oxygen delivery d/t congestion
hypervolemia/hemodilution
abdominal compartment syndrome/liver congestion/ ileus
increased extravasc lung water (impaired gas exchange)
26
the ability to tell if a patient is preload dependent or preload independent is assessed intraop by:
patient 02 sat/oxygen requirement
small fluid boluses of 200-250ml
response to vasopressors
response to leg lift
27
the fundemental objective of goal-direct fluid terapy is to optimize oxygen delivery
True
False
28
goal-direct fluid therapy attemps to optimize the patients position on the starling curve
True
False
29
key intraop components of ERAS that is under control of anesthesia provider
limiting use of drains
PONV prophylaxis
normothermia
mid-throacic epidural anesthesia
selecting short acting drugs
goal directed fluid therapy
