mortifera
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Which one of the following is the most important risk for the general anesthesia ?
a) Aortic insufficiency
b) Congestive Heart Failure
c) Acute MI history 3 months ago
d) Age of 70
e) Major surgery
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| filiz
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C :roll: General anesthesia may be related to an increase in blood pressure while the anesthetic drug is induced. It also may be associated with a higher risk for myocardial ischemia (mi"o-KAR'de-al is-KE'me-ah) (lack of oxygen to the heart muscle). This lack of oxygen can lead to heart attack.
:roll: Patients with heart disease have cardiovascular complications from general anesthesia and surgery more often and more severely than patients without heart disease. Emergency operations pose even greater risks. Still, the risk of having an operation for a specific disease condition must be balanced against the risk of not having one.
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| filiz
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http://www.americanheart.org/presenter.jhtml?iden...
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| mortifera
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yes that is true.
the most important risk for general anesthesia is the history of MI (especially in 6 months)
:wink:
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| Yulia
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mi"o-KAR'de-al is-KE'me-ah... that's a nice touch, filiz 
mortifera, what is the source of your question?
because i read that congestive heart failure actually possesses greater risk than history of myocadial infarction.
jvd or s3 gallop as an evidence of chf are ranked higher on goldman's scale...
if i am wrong, please do let me know.
have a great holidays!
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| mortifera
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Of course, there must be risk scales. This information is from the summary of Schwartz and there was a part of it that the most important risk for general anesthesia is acute MI. (at the question, all of the choices are risks)
CHF may be a greater risk than the history of MI but as I read, history of MI before 3 months(or earlier) is the most important one. (That's why I wrote : history of acute MI history 3 months ago)
and what are the details of goldman scale ?
thanks for informing.. As I don't know the details of the scale, I also may be wrong.
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| Yulia
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hi mortifera, thanks for the quick answer.
i don't understand what you're trying to say, chf is a greatest risk factor, but it is not the most important one??? how so? aren't riskiest things supposed to be most important? i don't get your point...
yes, well goldman scale is something that's used to assess cardiac risk of cardiac complications preoperatively. the risk factors are assigned numbers and whatever patient has, you add it and calculate the total risk.
Jvd or s3 gallop are 11 points on the scale. so they are the worst single predictors of cardiac complications.
history of mi is 10 points, it is close, but still less than chf.
age over 70 is 5 points
and so on...
so, if pt gets under 5 points - low risk - 1% risk of cardiac complications
6-12 - intermediate- 5% risk
12-25 - high risk
more than 25 points - very high risk of cardiac complications.
we don't need to know percentages for the exam.
Got that info from kaplan notes.
if anyone can add anything else from trusted sources, please step forward 
good luck to all of us!
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| mortifera
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Thanks.
What I meant was written at my previous answer.
There are two conditions :
a) History of MI (5 years ago)
b) History of MI (2 months ago)
Schwartz wrote that the second one is more important than CHF.
That's what I meant to say.
Thanks for information.
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