Routine Preoperative Evaluation in Surgical Patient

2019 ◽  
Author(s):  
Keyword(s):  
Preoperative Evaluation ◽  
Surgical Patient

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts
Keyword(s):  
Functional Status ◽  
Surgical Outcomes ◽  
Patient Population ◽  
Preoperative Evaluation ◽  
The Elderly ◽  
Diagnostic Approach ◽  
Surgical Patient ◽  
Specific Patient ◽  
Specific Patient Population ◽  
Specific Disease

The following is a detailed approach to the preoperative evaluation of the elderly surgical patient. A focus is placed on physiologic changes in the elderly that predispose them to complications and a systems-based approach to appropriate perioperative evaluation. Specifically, recommendations on the workup of cardiovascular, pulmonary, and renal systems are discussed. We also introduce the concept of frailty as a measure of an elderly patient's overall physiologic reserve. Finally, a diagnostic approach to common elderly-specific disease processes such as decreased functional status, malnutrition, and delirium is outlined. Throughout, an emphasis is placed on how to carefully assess this specific patient population and optimize preoperative functional status to improve surgical outcomes in the elderly. This review has 1 figure, 4 tables, and 62 references.

Pulmonary Diseases: Preoperative Assessment

2018 ◽  
Author(s):  
Suzanne Bennett ◽  
Quinn M Nguyen
Keyword(s):  
Risk Factors ◽  
Pulmonary Disease ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Pulmonary Complications ◽  
Perioperative Outcomes ◽  
Surgical Patient ◽  
Postoperative Pulmonary Complications ◽  
Related Risk ◽  
Obstructive Sleep

Postoperative pulmonary complications contribute to significant morbidity, mortality, and healthcare costs. The surgical patient with underlying pulmonary disease experiences a higher risk for postoperative pulmonary complications. Evaluation of the patient with pulmonary disease prior to surgery allows for the early identification of risk factors and opportunity for optimization resulting in improved perioperative outcomes for all surgical procedures. Complete understanding of the anesthetic options and their effect on pulmonary physiology and postoperative pulmonary complications assists in the evaluation and management of the patient with pulmonary disease. The patient-related risk factors, procedure-related risk factors, and risk factor stratification must be evaluated and performed while taking into consideration the risk and type of surgery. A thorough preoperative evaluation of the patient with pulmonary disease allows for the rational development of a multidisciplinary perioperative plan with the goal of reducing postoperative pulmonary complications. This review contains 5 figures, 7 tables, and 48 references. Keywords: assessment of perioperative risk, asthma, bronchitis, cessation of smoking, COPD, emphysema, obstructive sleep apnea, perioperative smoking, Pulmonary Function Tests (PFTs), nitrogen washout

Preoperative Evaluation of the Cardiac Surgical Patient

2019 ◽  
pp. 3-10
Author(s):  
Rebecca M. Gerlach
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Carotid Artery Disease ◽  
Perioperative Complications ◽  
Preoperative Evaluation ◽  
Surgical Patient ◽  
Efficient Manner ◽  
Obstructive Sleep ◽  
Reduce Risk ◽  
Artery Disease

Patients undergoing cardiac surgery are at elevated risk for perioperative complications; however, certain risk factors may be modifiable. Preoperative evaluation performed in advance of surgery provides an opportunity for the perioperative anesthesiologist to intervene to reduce risk. Performing a focused history and physical examination informs the selection of appropriate preoperative tests. Risk assessment via tools specific to cardiac surgery provide a detailed risk profile. Certain diseases common to cardiac surgical patients deserve particular focus during assessment. Poorly controlled diabetes mellitus and resultant hyperglycemia are modifiable risk factors. Undiagnosed obstructive sleep apnea is common and associated with postoperative complications. Concurrent carotid artery disease presents a management conundrum requiring multidisciplinary planning. Preoperative anemia is common; when due to iron deficiency, it is easily treated to improve outcomes. In addition to gathering information about the patient, the goal of preoperative evaluation is to identify ways to reduce risk and improve outcome from surgery in a resource-efficient manner.

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