CAPA (ABPANC) cheat sheet

ASA fasting intervals: clear liquids 2 h; breast milk 4 h; infant formula, nonhuman milk, and light meal 6 h; fried, fatty, or meat-containing meal 8 h.

Mallampati class I-IV; class III (soft palate plus base of uvula only) and IV (hard palate only) predict difficult intubation and mask ventilation.

ASA physical status I-VI, with suffix E for emergency; class III or higher correlates with increased perioperative risk.

STOP-BANG: snoring, tiredness, observed apnea, pressure (hypertension), BMI >35, age >50, neck circumference >40 cm, male sex; score >=3 intermediate and >=5 high OSA risk.

Beta-blockers are generally continued; metformin and ACE inhibitors/ARBs are commonly held per protocol, and anticoagulant interruption is individualized to bleeding versus thrombotic risk.

History of malignant hyperthermia or unexplained anesthetic death mandates avoidance of volatile agents and succinylcholine, with dantrolene immediately available.

Valid consent requires diagnosis, nature and purpose of the procedure, risks and benefits, alternatives, and the right to refuse, confirmed before sedation begins.

Baseline assessment includes airway and dentition, allergies including latex, prior anesthetic complications, NPO status, vital signs, and documented weight for weight-based dosing.

The sedation continuum runs from minimal anxiolysis to moderate sedation, deep sedation, and general anesthesia; a patient can move to a deeper level unpredictably at any time.

Moderate sedation: purposeful response to verbal or light tactile stimulation, airway patent without intervention, spontaneous ventilation adequate, cardiovascular function usually maintained.

Deep sedation: purposeful response only after repeated or painful stimulation, airway intervention may be required, and spontaneous ventilation may be inadequate.

Standard monitoring during procedural sedation includes pulse oximetry, capnography, ECG, intermittent blood pressure, and continuous observation of ventilation and responsiveness.

Naloxone 0.04-0.4 mg IV titrated every 2-3 minutes; flumazenil 0.2 mg IV repeated to a maximum of 1 mg, with seizure risk in benzodiazepine-dependent patients.

Maximum local anesthetic doses: lidocaine 4.5 mg/kg plain and 7 mg/kg with epinephrine; bupivacaine 2.5-3 mg/kg, not to exceed roughly 175 mg plain.

Local anesthetic systemic toxicity: stop injection, secure airway with 100% oxygen, control seizures with benzodiazepine, give 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion.

Aspiration risk increases with full stomach, GERD, obesity, diabetes, bowel obstruction, and emergency surgery; these patients warrant modified technique and rapid sequence considerations.

Aldrete score rates activity, respiration, circulation, consciousness, and oxygen saturation 0-2 each for a maximum of 10; a score of 9 or higher is typically required to leave phase I.

Apfel predictors for PONV are female sex, nonsmoker status, prior PONV or motion sickness, and postoperative opioids; each adds roughly 20% risk.

Malignant hyperthermia: discontinue triggering agents, hyperventilate with 100% oxygen, give dantrolene 2.5 mg/kg IV repeated to 10 mg/kg, cool the patient, and treat hyperkalemia and acidosis.

Laryngospasm: remove the stimulus, apply 100% oxygen with jaw thrust and CPAP; if it persists, use propofol 0.5-1 mg/kg IV or succinylcholine 0.5-1 mg/kg IV.

Phase I recovery provides continuous monitoring until phase I criteria are met; phase II recovery is a lower-intensity setting preparing the patient for discharge.

Multimodal PONV prophylaxis combines different drug classes such as 5-HT3 antagonists, dexamethasone, droperidol, scopolamine, and NK1 antagonists rather than repeating one agent.

Patients with obstructive sleep apnea need extended monitoring, capnography, head-of-bed elevation, and cautious opioid dosing in the postprocedure period.

Findings that must be escalated immediately include SpO2 below 90%, respiratory rate below 8, temperature above 38.3 C, hypotension, active bleeding, severe pain, and urinary retention.

Discharge criteria: stable airway, oxygen saturation at baseline on room air, Aldrete 9 or higher or PADSS 9 or higher, controlled pain and nausea, no active bleeding, and appropriate ambulation.

A responsible adult escort must accompany the patient home and remain with them overnight after sedation or anesthesia.

For 24 hours after sedation or anesthesia patients must not drive, operate machinery, drink alcohol, sign legal documents, or make significant decisions.

Instructions are given both verbally and in writing at an appropriate reading level, then confirmed with the teach-back method.

Documentation includes the content taught, the method used, who received the instructions (patient or caregiver), the patient's demonstrated understanding, and that a copy was provided.

Red-flag symptoms to report: temperature above 38 C, uncontrolled bleeding, shortness of breath, chest pain, persistent vomiting, inability to void, and worsening pain.

Discharge paperwork includes provider contact numbers, emergency instructions, and any scheduled follow-up appointment; routine telephone follow-up occurs within 24-48 hours.

Two independent patient identifiers, such as name and date of birth, are verified before every medication, procedure, and blood product administration.

The universal protocol consists of preprocedure verification, site marking, and a spoken time-out confirming patient, site, procedure, consent, and imaging.

SBAR (Situation, Background, Assessment, Recommendation) is the structured format used for handoffs during transfer of care.

The fire triangle requires an oxidizer, an ignition source, and fuel; eliminating any one side prevents or extinguishes a procedural fire, and RACE governs evacuation.

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury and triggers a root cause analysis with reporting per policy.

ASPAN standards address staffing, environment of care, patient assessment, monitoring, and discharge criteria across the phases of perianesthesia care.

Medication safety practice requires immediate labeling of all syringes, independent double-checks of high-alert drugs, and separation of look-alike/sound-alike products.

Nursing scope of practice is defined by the state nurse practice act and refined by facility policy, credentialing, and unit competency validation.