CANPC cheat sheet

ASA Physical Status: I healthy; II mild systemic disease; III severe systemic disease; IV constant threat to life; V moribund, not expected to survive without operation; add E for emergency.

Revised Cardiac Risk Index (RCRI) predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2.0 mg/dL, and high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular); each scores 1 point.

RCRI estimated major cardiac event risk: 0 predictors ~0.4%, 1 ~0.9%, 2 ~7%, 3 or more ~11%.

Active upper respiratory infection in a child raises risk of perioperative bronchospasm and laryngospasm; elective airway instrumentation is generally deferred until symptoms resolve.

Current guidelines generally do not require routine stress testing before low- or intermediate-risk surgery in asymptomatic patients who can perform activities of daily living.

Metformin is typically continued perioperatively when renal function is normal; contrast-related concern centers on patients with preexisting renal impairment.

Enhanced recovery protocols emphasize preoperative carbohydrate loading, avoidance of prolonged fasting, multimodal analgesia, and early ambulation.

Informed consent requires disclosure of diagnosis, proposed procedure, material risks and benefits, alternatives, and the right to refuse.

MAC (minimum alveolar concentration) is the alveolar concentration at end-expiration that prevents movement in 50% of subjects in response to a standard surgical stimulus.

MAC values approximate: desflurane 6%, sevoflurane 2%, isoflurane 1.15%, nitrous oxide 105%; MAC is additive when agents are combined.

MAC-awake (no response to command) is roughly 0.34 MAC; MAC-BAR (blunting autonomic response) is roughly 1.5-2.0 MAC.

Propofol induction dose is approximately 1.5-2.5 mg/kg IV in healthy adults; reduced in the elderly, hypovolemic, or hemodynamically unstable.

Succinylcholine 1-1.5 mg/kg IV produces rapid onset and brief duration; contraindicated in hyperkalemia risk states such as burns, crush injury, denervation, and malignant hyperthermia susceptibility.

Rocuronium 0.6-1.2 mg/kg IV; sugammadex 2 mg/kg reverses moderate blockade, 4 mg/kg reverses deep blockade, 16 mg/kg for immediate post-relaxant rescue.

Local anesthetic maximum doses (with epinephrine): lidocaine 7 mg/kg; bupivacaine 3 mg/kg; mepivacaine 7 mg/kg.

Malignant hyperthermia is treated with dantrolene 2.5 mg/kg IV, repeated until symptoms abate, with hyperventilation, cooling, and treatment of hyperkalemia and acidosis.

Moderate sedation requires independent observation of the patient's responsiveness and vital signs; deep sedation or general anesthesia requires an anesthesia professional.

Mallampati classes: I soft palate, uvula, fauces visible; II uvula masked by base of tongue; III only soft and hard palate visible; IV only hard palate visible.

Difficult mask ventilation predictors include age >55, BMI >26, edentulous state, beard, history of snoring, and limited jaw protrusion.

LEMON airway assessment: Look externally, Evaluate 3-3-2 rule, Mallampati, Obstruction, Neck mobility.

3-3-2 rule: mouth opening of 3 fingerbreadths, hyoid-mental distance of 3 fingerbreadths, thyromental distance of 2 fingerbreadths.

Cormack-Lehane laryngoscopy grades: I full glottic opening; II partial vocal cords; III epiglottis only; IV no glottic structures visible.

Cannot intubate, cannot oxygenate calls for an emergency invasive airway, such as surgical cricothyrotomy in adults.

Capnography waveform presence is the standard confirmation of endotracheal tube placement; sustained absence mandates immediate evaluation.

Laryngeal mask airway is a supraglottic device; it does not protect against aspiration and is not appropriate for patients with high aspiration risk.

Preoxygenation with 100% oxygen for 3-5 minutes provides a reservoir that extends safe apnea time, especially in obese and pregnant patients.

Standard monitoring includes pulse oximetry, capnography, ECG, noninvasive blood pressure, temperature, and inspired oxygen concentration.

MAP = (SBP + 2 x DBP) / 3; a MAP of at least 65 mmHg is the common target for adequate organ perfusion.

Mean arterial pressure is approximately (cardiac output x systemic vascular resistance) + central venous pressure.

Pulse oximetry becomes unreliable with poor perfusion, motion, ambient light, dyshemoglobinemias such as carboxyhemoglobin, and methemoglobinemia.

Capnography during CPR shows a sudden rise in end-tidal CO2 as an indicator of return of spontaneous circulation.

A sudden drop in end-tidal CO2 can indicate hypovolemia, pulmonary embolism, decreased cardiac output, or circuit disconnection; a sudden rise can indicate hypermetabolism or return of circulation.

Invasive arterial lines allow continuous beat-to-beat pressure monitoring and arterial blood gas sampling; complications include thrombosis, hematoma, and infection.

Central venous pressure is a poor predictor of fluid responsiveness; dynamic measures such as pulse pressure variation and passive leg raise are more reliable.

Multimodal analgesia combines agents with different mechanisms (opioids, NSAIDs, acetaminophen, local anesthetics, adjuncts) to improve efficacy and reduce opioid requirements.

Acetaminophen dosing is limited to 4 g/day in healthy adults; lower limits apply in hepatic impairment and chronic alcohol use.

NSAIDs are generally avoided in patients with renal impairment, peptic ulcer disease, or significant bleeding risk, and after some bone-healing procedures.

Opioid-related adverse effects include respiratory depression, sedation, constipation, nausea, and pruritus; naloxone reverses opioid-induced respiratory depression.

Neuraxial opioids: lipophilic agents such as fentanyl have faster onset and shorter duration; hydrophilic agents such as morphine have delayed onset and longer duration, with risk of delayed respiratory depression.

Local anesthetic systemic toxicity presents with perioral numbness, tinnitus, seizures, and cardiovascular collapse; treatment is 20% lipid emulsion.

Pain scores should be assessed at rest and with movement; numeric rating scales are commonly used in adults, while faces scales are used in children.

Patient-controlled analgesia with background infusion carries a higher risk of respiratory depression than demand-only dosing.

Apfel simplified risk score for postoperative nausea and vomiting: female sex, nonsmoker, history of PONV or motion sickness, and postoperative opioids; each scores 1 point.

Estimated PONV risk by Apfel score: 0 points ~10%, 1 point ~20%, 2 points ~40%, 3 points ~60%, 4 points ~80%.

5-HT3 antagonists such as ondansetron 4 mg IV are commonly used for prophylaxis and treatment; QT prolongation is a consideration.

Dexamethasone 4-8 mg IV given after induction is an effective antiemetic adjunct with delayed benefit.

Droperidol and haloperidol are dopamine antagonists used for PONV; sedation and QT prolongation are concerns.

Scopolamine transdermal patch provides prophylaxis via anticholinergic action; dry mouth and confusion are adverse effects.

Aprepitant, an NK-1 receptor antagonist, is used for PONV prophylaxis in high-risk patients or those with refractory symptoms.

Combining agents from different classes is more effective than escalating a single agent for rescue.

Malignant hyperthermia presents with hypercarbia, masseter spasm, rigidity, hyperthermia, and acidosis; treat with dantrolene and supportive measures.

Anaphylaxis is treated with epinephrine 0.1-0.5 mg IM (or titrated IV in severe cases), fluids, oxygen, and antihistamines as adjuncts.

Laryngospasm presents with stridor, hypoxemia, and absent capnography; management includes 100% oxygen, CPAP, deepening anesthesia, and low-dose succinylcholine if persistent.

Postoperative respiratory depression from opioids is identified by decreased respiratory rate, sedation, and rising end-tidal CO2; naloxone is the antidote.

Atelectasis is the most common early postoperative pulmonary complication; incentive spirometry and early ambulation reduce risk.

Venous thromboembolism risk rises with immobility, malignancy, and major orthopedic surgery; mechanical and pharmacologic prophylaxis are used per risk.

Emergence delirium and emergence agitation are common in children after sevoflurane anesthesia; symptoms are typically self-limited.

Acute postoperative pain plus tachycardia, hypotension, and oliguria may indicate hemorrhage; assess drains, dressings, and hemoglobin.

The WHO Surgical Safety Checklist has three phases: sign in before induction, time out before incision, and sign out before the patient leaves the operating room.

Surgical site marking should occur before the patient enters the operating room, with the patient involved when possible.

The Universal Protocol requires preprocedure verification, site marking, and a time-out immediately before the procedure.

Medication errors are reduced by standardized labeling of syringes, color coding, and double checks for high-alert medications.

Retained surgical items are prevented by standardized counts and radiopaque sponges with intraoperative imaging when counts are discrepant.

Hand hygiene per WHO five moments reduces health care-associated infection; alcohol-based rubs are preferred when hands are not visibly soiled.

Root cause analysis is a structured method to identify system-level contributors to adverse events, distinct from individual blame.

Near-miss reporting and a just culture encourage disclosure and learning rather than punishment for honest errors.

Informed consent requires patient capacity, adequate disclosure, comprehension, voluntariness, and authorization of the procedure.

Decision-making capacity includes understanding, appreciation, reasoning, and expressing a choice; it is decision-specific and can fluctuate.

Advance directives, including living wills and durable power of attorney for health care, guide care when the patient lacks capacity.

In emergencies with imminent harm, treatment may proceed under implied consent when the patient cannot consent and no surrogate is available.

Confidentiality is breached only with patient authorization, legal mandate, or a serious public health threat; HIPAA governs protected health information.

Conflict of interest must be disclosed; financial relationships with industry should not influence clinical recommendations.

Professionalism includes honesty, respect, accountability, and appropriate boundaries with patients and colleagues.

Mandatory reporting obligations vary by jurisdiction and may include certain communicable diseases, abuse, and impaired colleagues posing risk.