p.25
Estimating Blood Loss
How do you calculate the maximum allowable blood loss?
Using the formula: (Preoperative hematocrit - Lowest allowable hematocrit) / Preoperative hematocrit x Blood volume.
p.14
Maintenance Fluid Calculations
What is the maintenance fluid requirement for a 75 kg patient?
Approximately 3,000 mL per day.
p.13
Fluid Therapy in Surgery
What type of loss is included in surgical loss during fluid therapy?
Losses not including blood loss.
p.22
Estimating Blood Loss
How do you estimate estimated blood loss (EBL) using soaked gauze?
15 soaked 4 x 4's and 3 soaked lap pads.
p.3
Electrolyte Concentrations
What role does calcium play in plasma potassium concentration?
Calcium administration does not decrease plasma potassium concentration.
p.4
Fluid Therapy in Surgery
What happens to cells in a hypertonic solution?
Cells lose water and shrink.
p.19
Maintenance Fluid Calculations
What is the maintenance fluid calculation for an 80 kg patient?
40 + 20 + 60 = 120 ml/hr.
p.21
Fluid Therapy in Surgery
What is the maintenance fluid calculation for a 60 kg patient?
40 + 20 + 40 = 100 ml/hr.
p.20
Fluid Therapy in Surgery
What is the total fluid plan for a 4-hour surgical case?
Sum of hourly maintenance, fluid deficit, and anticipated surgical fluid loss over 4 hours.
p.34
Estimating Blood Loss
What is the patient's hemoglobin and hematocrit (H/H) preoperatively?
Hemoglobin 12 and hematocrit 36.
p.36
Enhanced Recovery After Surgery (ERAS)
What is the main focus of Enhanced Recovery After Surgery (ERAS)?
To improve recovery outcomes for patients undergoing surgery.
p.13
Fluid Therapy in Surgery
What should be considered regarding preexisting conditions in fluid therapy?
Preexisting fluid deficits.
p.2
Electrolyte Concentrations
How can electrolyte imbalances occur?
Through dehydration, excessive sweating, certain medications, or underlying health conditions.
p.22
Estimating Blood Loss
What additional volume should be considered for irrigation during EBL estimation?
200 ml of irrigation used.
p.4
Fluid Therapy in Surgery
What is the effect of isotonic solutions on cell volume?
Isotonic solutions do not change cell volume.
p.26
Estimating Blood Loss
How is the maximum allowable blood loss (ABL) calculated?
ABL = [EBV x (Preoperative hematocrit - Lowest allowable hematocrit)] / Preoperative hematocrit.
p.20
Maintenance Fluid Calculations
What is the fluid deficit for a patient NPO for 12 hours?
12 hours x hourly maintenance rate.
p.34
Fluid Therapy in Surgery
What surgical procedure is planned for the patient?
Total abdominal hysterectomy.
p.20
Fluid Therapy in Surgery
How do you distribute fluids over the 4-hour surgical period?
Divide total fluid volume by 4 for each hour.
p.34
Fluid Therapy in Surgery
What is the patient's past medical history relevant to this case?
Motor vehicle accident (MVA) 10 years ago resulting in paralysis.
p.37
Enhanced Recovery After Surgery (ERAS)
What routine procedure should be avoided in the preoperative period?
Routine mechanical bowel preparation.
p.37
Enhanced Recovery After Surgery (ERAS)
What type of analgesia is recommended to limit opioid utilization?
Multimodal analgesia agents.
p.33
Estimating Blood Loss
What is the estimated blood volume of a 154 lb male that is 6'0” tall?
Approximately 6.5 liters.
p.13
Fluid Therapy in Surgery
What does 'normal losses' refer to in fluid therapy?
Maintenance requirements for fluid replacement.
p.7
Impact of Hypermagnesemia on Anesthesia
How does hypermagnesemia affect acetylcholine (Ach) release at the motor end plate?
It increases Ach release.
p.27
Massive Transfusion Protocol
What electrolyte changes are expected during a massive transfusion protocol?
Hypocalcemia, hyperkalemia, and hypomagnesemia.
What is the purpose of colloid solutions in fluid therapy?
To maintain oncotic pressure and expand blood volume.
p.37
Enhanced Recovery After Surgery (ERAS)
What is the goal during the intraoperative period of ERAS?
To decrease the physiologic stress response to surgery.
p.23
Estimating Blood Loss
What is the total estimated blood loss calculation?
150 ml + 300 ml + 600 ml = 1050 ml.
p.5
Fluid Therapy in Surgery
What is D5 ½ NS?
5% dextrose in 0.45% saline.
p.2
Electrolyte Concentrations
What are electrolytes?
Minerals in the body that carry an electric charge.
p.7
Impact of Hypermagnesemia on Anesthesia
What sympathetic response does hypermagnesemia blunt during laryngoscopy?
It blunts the sympathetic response.
p.19
Fluid Therapy in Surgery
What is the total fluid administered during the first three surgical hours?
Total: 920 mL (Hour 1) + 680 mL (Hour 2) + 680 mL (Hour 3).
p.18
Fluid Therapy in Surgery
What is the anticipated surgical fluid loss for a lap bowel resection?
Typically estimated at 5-10 ml/kg/hour, depending on the procedure.
p.28
Estimating Blood Loss
How much would an 80 kg patient's Hgb/HCT increase after receiving 400 ml of PRBCs?
Approximately 1 g/dL for hemoglobin and about 3% for hematocrit.
p.24
Estimating Blood Loss
How can the weight of sponges be used to estimate blood loss?
By weighing soaked sponges and subtracting the dry weight; 1 gram equals 1 milliliter of blood.
p.14
Maintenance Fluid Calculations
What is the maintenance fluid requirement for a 15 kg patient?
Approximately 1,200 mL per day.
p.36
Enhanced Recovery After Surgery (ERAS)
What is one key component of ERAS protocols?
Optimizing nutrition before and after surgery.
p.18
Fluid Therapy in Surgery
How do you calculate the fluid deficit for a patient NPO for 8 hours?
Fluid deficit = hourly maintenance rate x number of fasting hours.
p.33
Estimating Blood Loss
What is the estimated blood volume of a 370 lb male that is 6'0” tall?
Approximately 8.5 liters.
p.10
Transfusion Guidelines and Effects
Which blood types are compatible with a patient who has AB+ blood type?
All of the above (A negative, B positive, O negative).
p.32
Estimating Blood Loss
What is the intervention for a hypotensive patient with a Stroke Volume Variation (SVV) of 10%?
Consider fluid resuscitation.
p.27
Massive Transfusion Protocol
What is hyperkalemia and why can it occur during massive transfusion?
Elevated potassium levels, often due to the release of potassium from stored red blood cells.
p.24
Estimating Blood Loss
How can blood loss be estimated during surgery?
By measuring blood within suction canisters and soaked surgical sponges.
p.24
Estimating Blood Loss
What is the formula to calculate blood loss using sponge weight?
Soaked weight (g) - dry weight (g) = blood loss (mL).
p.20
Maintenance Fluid Calculations
How do you calculate hourly maintenance fluid for a 60 kg patient?
Using the 4-2-1 rule: 4 mL/kg for the first 10 kg, 2 mL/kg for the next 10 kg, and 1 mL/kg for each kg above 20 kg.
p.20
Estimating Blood Loss
How do you calculate anticipated surgical fluid loss?
Estimate based on the type of surgery and expected blood loss.
p.20
Fluid Therapy in Surgery
What is the total fluid volume for the first hour of surgery?
Hourly maintenance + fluid deficit + anticipated loss for the first hour.
p.21
Fluid Therapy in Surgery
What is the total fluid administered in the first four hours of surgery?
1180 ml, 880 ml, 880 ml, 580 ml.
p.37
Enhanced Recovery After Surgery (ERAS)
What is the goal for patients in the preoperative period of ERAS?
To arrive in the OR in a euvolemic state.
p.11
Electrolyte Concentrations
What may occur with the rapid correction of hyponatremia?
Osmotic demyelination syndrome.
p.12
Clinical Manifestations of Hypocalcemia
What is Trousseau's sign?
A clinical manifestation of hypocalcemia characterized by carpal spasm when a blood pressure cuff is inflated.
p.7
Impact of Hypermagnesemia on Anesthesia
What is the effect of hypermagnesemia on opioid requirements during anesthesia?
It reduces opioid requirements.
p.37
Enhanced Recovery After Surgery (ERAS)
What type of fluids are allowed up to 2 hours prior to surgery?
Clear fluids, including carbohydrate drinks.
p.37
Enhanced Recovery After Surgery (ERAS)
What should be done early in the postoperative period regarding IV fluids and drains?
Early discharge of IV fluids, NG tube, and drains.
p.18
Fluid Therapy in Surgery
How do you create an hourly fluid plan for a 3-hour surgical case?
Calculate total maintenance, deficit, and anticipated loss, then distribute fluids evenly across the surgical hours.
p.13
Fluid Therapy in Surgery
What are the standard fluid replacement considerations in perioperative fluid therapy?
1. Normal losses (maintenance requirements), 2. Preexisting fluid deficits, 3. Surgical loss (not including blood loss).
p.32
Estimating Blood Loss
What is the intervention for a hypotensive patient with a Stroke Volume Variation (SVV) of 20%?
Consider administering vasopressors.
p.2
Electrolyte Concentrations
Why are electrolytes important?
They help regulate nerve and muscle function, hydrate the body, balance blood acidity and pressure, and help rebuild damaged tissue.
p.3
Electrolyte Concentrations
What effect does epinephrine have on plasma potassium concentration?
It decreases plasma potassium concentration.
What is the role of crystalloid in fluid replacement?
To restore intravascular volume.
p.14
Maintenance Fluid Calculations
What is the maintenance fluid requirement for a 100 kg patient?
Approximately 4,000 mL per day.
p.37
Enhanced Recovery After Surgery (ERAS)
What anesthesia consideration is suggested during the intraoperative period?
Consider regional anesthesia.
p.36
Enhanced Recovery After Surgery (ERAS)
How does ERAS benefit patients post-surgery?
By promoting faster recovery and shorter hospital stays.
p.12
Clinical Manifestations of Hypocalcemia
What is Chvostek's sign?
A clinical manifestation of hypocalcemia where tapping on the facial nerve causes twitching of the facial muscles.
p.2
Electrolyte Concentrations
Name some common electrolytes.
Sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphate.
p.22
Estimating Blood Loss
What is the total estimated blood loss (EBL) calculation based on the provided data?
Total EBL = (15 soaked 4 x 4's + 3 soaked lap pads + 800 ml in suction + 200 ml irrigation).
p.4
Fluid Therapy in Surgery
What is a hydrotonic solution?
Hydrotonic is not a standard term in fluid therapy.
Which option provides the correct fluid replacement for an EBL of 2000 mL?
A. 1200 mL crystalloid; 500 mL colloid; 500 mL PRBC.
p.34
Fluid Therapy in Surgery
What is the diagnosis for the patient in the case scenario?
Menorrhagia with abdominal pain.
p.34
Estimating Blood Loss
What is the maximum allowable blood loss based on the lowest hematocrit?
Lowest hematocrit is 28%.
p.37
Enhanced Recovery After Surgery (ERAS)
What is the goal for the postoperative period in ERAS?
To promote early mobilization and discharge.
p.23
Estimating Blood Loss
What is the remaining volume in the suction canister after accounting for irrigation?
600 ml (800 ml - 200 ml).
p.3
Electrolyte Concentrations
What effect does insulin have on plasma potassium concentration?
It decreases plasma potassium concentration.
p.27
Massive Transfusion Protocol
Why might hypocalcemia occur during massive transfusion?
Due to citrate in stored blood binding calcium.
p.14
Maintenance Fluid Calculations
What is the maintenance fluid requirement for a 60 kg patient?
Approximately 2,400 mL per day.
p.35
Fluid Therapy in Surgery
What are the patient's medical history conditions?
Osteoporosis and hypertension (HTN).
p.36
Enhanced Recovery After Surgery (ERAS)
What does ERAS aim to minimize during the surgical recovery process?
Pain, stress, and complications.
p.36
Enhanced Recovery After Surgery (ERAS)
What type of approach does ERAS utilize?
A multidisciplinary approach involving various healthcare professionals.
p.18
Fluid Therapy in Surgery
What is the formula to calculate hourly maintenance fluid for an 80 kg patient?
Using the 4-2-1 rule: 4 ml/kg for the first 10 kg, 2 ml/kg for the next 10 kg, and 1 ml/kg for the remaining weight.
p.18
Fluid Therapy in Surgery
What is the total fluid requirement for an 80 kg patient over 3 hours?
Total fluid = maintenance + deficit + anticipated loss over 3 hours.
