Preoperative evaluation of coagulation status in neuromodulation patients

2021 ◽  
pp. 1-7
Author(s):  
Amir Hadanny ◽  
Zachary T. Olmsted ◽  
Anthony M. Marchese ◽  
Kyle Kroll ◽  
Christopher Figueroa ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
New Anticoagulants ◽  
Laboratory Values ◽  
Normal Ranges ◽  
Hematological Analysis ◽  
Coagulation Status ◽  
Pump Implantation ◽  
Deep Brain

OBJECTIVE The incidence of hemorrhage in patients who undergo deep brain stimulation (DBS) and spinal cord stimulation (SCS) is between 0.5% and 2.5%. Coagulation status is one of the factors that can predispose patients to the development of these complications. As a routine part of preoperative assessment, the authors obtain prothrombin time (PT), partial thromboplastin time (PTT), and platelet count. However, insurers often cover only PT/PTT laboratory tests if the patient is receiving warfarin/heparin. The authors aimed to examine their experience with abnormal coagulation parameters in patients who underwent neuromodulation. METHODS Patients who underwent neuromodulation (SCS, DBS, or intrathecal pump implantation) over a 9-year period and had preoperative laboratory values available were included. The authors determined abnormal values on the basis of a clinical protocol utilized at their practice, which combined the normal ranges of the laboratory tests and clinical relevance. This protocol had cutoff values of 12 seconds and 39 seconds for PT and PTT, respectively, and < 120,000 platelets/μl. The authors identified risk factors for these abnormalities and described interventions. RESULTS Of the 1767 patients who met the inclusion criteria, 136 had abnormal preoperative laboratory values. Five of these 136 patients had values that were misclassified as abnormal because they were within the normal ranges at the outside facility where they were tested. Fifty-one patients had laboratory values outside the ranges of our protocol, but the surgeons reviewed and approved these patients without further intervention. Of the remaining 80 patients, 8 had known coagulopathies and 24 were receiving warfarin/heparin. The remaining 48 patients were receiving other anticoagulant/antiplatelet medications. These included apixaban/rivaroxaban/dabigatran anticoagulants (n = 22; mean ± SD PT 13.7 ± 2.5 seconds) and aspirin/clopidogrel/other antiplatelet medications (n = 26; mean ± SD PT 14.4 ± 5.8 seconds). Eight new coagulopathies were identified and further investigated with hematological analysis. CONCLUSIONS New anticoagulants and antiplatelet medications are not monitored with PT/PTT, but they affect coagulation status and laboratory values. Although platelet function tests aid in a subset of medications, it is more difficult to assess the coagulation status of patients receiving novel anticoagulants. PT/PTT may provide value preoperatively.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

Effectiveness and security of trained nurses in preoperative assessment within the outpatient preoperative evaluation clinic

2006 ◽  
Vol 23 (Supplement 37) ◽  
pp. 244-245
Author(s):  
J. Mata ◽  
C. Segura ◽  
I. Valldeperas ◽  
P. Valentí ◽  
A. Ferrer ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Preoperative Evaluation Clinic

Transsphenoidal/Pituitary Surgery

2018 ◽  
Author(s):  
Vaia T. Abatzis ◽  
Edward C. Nemergut
Keyword(s):  
Pituitary Gland ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Pituitary Surgery ◽  
Anesthetic Care ◽  
Anesthetic Agents ◽  
Intraoperative Management ◽  
Transsphenoidal Pituitary Surgery ◽  
Early Diagnosis Of Diabetes

Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient’s endocrine disease. Although patients presenting with Cushing’s disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. Postoperatively, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI). DI is most often transient but can require medical therapy. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

Systematic Functional Assessment of Nasal Dyspnea

2011 ◽  
Vol 145 (5) ◽  
pp. 845-850 ◽  
Author(s):  
Daniel A. Larson ◽  
Benjamin W. Cilento
Keyword(s):  
Success Rate ◽  
Preoperative Evaluation ◽  
Tertiary Care ◽  
Case Series ◽  
Predictive Ability ◽  
Preoperative Assessment ◽  
Military Hospital ◽  
Significant Difference ◽  
Vas Scores ◽  
Outcome Of Surgery

Objective. Evaluate the ability of a systematic preoperative evaluation to determine the most appropriate procedures for patients undergoing functional septorhinoplasty and to accurately predict postoperative outcomes. Study Design. Case series with chart review. Setting. Tertiary care military hospital. Subjects and Methods. Fifty-nine consecutive patients from a quality control database who underwent functional rhinoplasties for nasal dyspnea were evaluated. All patients underwent a full preoperative assessment using intranasal manipulation to determine the area(s) contributing to their nasal dyspnea. Rates of success for the predictive ability and for the functional outcome were determined for each side of the nose by comparing preoperative visual analog scale (VAS) scores (1-10) to postoperative scores. Results. Overall there was a 91% success rate in predicting the outcome of surgery and a 95% success rate in improving nasal dyspnea at 1 year. There was no statistically significant difference in improvement between different surgical groups (septoplasty ± alar strut grafts ± spreader grafts) or between primary surgeries and revisions. Conclusion. Using a systematic approach to evaluate patients for nasal dyspnea, it is possible to predict and improve outcomes by choosing the most appropriate surgery for each individual.

scholarly journals A novel template for anorectal fistula reporting in anal endosonography and MRI – a practical concept

2019 ◽  
Vol 21 (4) ◽  
pp. 483
Author(s):  
Iwona Sudoł-Szopińska ◽  
Małgorzata Kołodziejczak ◽  
Giulio Santoro Aniello
Keyword(s):  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Fistula Tract ◽  
Anal Endosonography ◽  
Anorectal Fistula ◽  
Resonance Imaging ◽  
Anal Sphincters ◽  
Fistula Surgery ◽  
Magnetic Resonance Imaging Mri

Anorectal fistula surgery is associated with risks of recurrence and/or faecal incontinence due to anal sphincter injuries. In order to minimise these complications, preoperative evaluation of the anatomy of the fistula tract and morphology of the anal sphincters is mandatory. Anal endosonography (AES) and Magnetic Resonance Imaging (MRI), due to high resolution of images and ability to identify a number of fistula elements which are important for surgeons in treatment planning, are the methods of choice in the diagnosis of anorectal fistulas.In this paper, a new template for endosonographic and MRI report, systematically describing all anorectal fistula’s characteristics, is presented. This template provides practical information for the surgeon, useful in preoperative assessment and postoperative follow-up.

scholarly journals Preoperative assessment and preparation of patients with diseases affecting the central nervous system

2011 ◽  
Vol 58 (2) ◽  
pp. 83-90 ◽  
Author(s):  
Branko Milakovic ◽  
Ivan Dimitrijevic ◽  
Vesna Malenkovic ◽  
Dejan Markovic ◽  
Vesna Pantic-Palibrk ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cerebral Autoregulation ◽  
Neuroprotective Effect ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Positive Pressure ◽  
Anesthetic Drugs ◽  
The Central Nervous System ◽  
Bedside Method

Purpose of review: This review will examine the most important issues of preoperative evaluation and preparation in relation to patients with deseases affecting the central nervous system. Those patients may undergo various forms of surgery unrelated to the central nervous system disease. We discuss the effect of physiologic and pharmacological factors on cerebral autoregulation and control of intracranial pressure alongside its clinical relevance with the help of new evidence. Recent findings: Regardless of the reason for surgery, coexisting diseases of brain often have important implications when selecting anesthetic drugs, procedures and monitoring techniques. Suppression of cerebral metabolic rate is not the sole mechanism for the neuroprotective effect of anaesthetic agents. There are certain general principles, but also some specific circumstances, when we are talking about optimal anesthetic procedure for a patient with coexisting brain disease. Intravenous anesthesia, such as combination of propofol and remifentanil, provides best preservation of autoregulation. Among inhaled agents isoflurane and sevoflurane appear to preserve autoregulation at all doses, whereas with other agents autoregulation is impaired in a dose-related manner. During maintenance of anesthesia the patient is ventilated by intermittent positive pressure ventilation, at intermediate hyperventilation (PaCO2 25 - 30 mmHg). Summary: Intraoperative cerebral autoregulation monitoring is an important consideration for the patients with coexisting neurological disease. Transcranial Doppler based static autoregulation measurements appears to be the most robust bedside method for this purpose.

Evaluating Bariatric Surgical Risk Using Risk-Scoring Systems

2018 ◽  
Author(s):  
Eric J. DeMaria ◽  
Claudia Jin Kim
Keyword(s):  
Risk Stratification ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Scoring Systems ◽  
Low Risk ◽  
Morbidly Obese ◽  
Free Standing ◽  
Surgical Risk ◽  
Selective Basis ◽  
Risk Patients

Surgical risk assessment is a critical aspect of delivering safe bariatric and metabolic surgery care today. Years ago, there were no useful methodologies to differentiate morbidly obese patients based on surgical risk stratification. Today there are numerous available strategies that can identify patients at higher risk for complications and for otherwise poor results, such as insufficient weight loss and suboptimal resolution of comorbid medical conditions. These strategies can guide the preoperative evaluation, allow the provider to better inform the patient regarding risk, and allow for more aggressive perioperative care to be instituted on a selective basis, thus lowering overall costs of care. Identification of low-risk patients undergoing low-risk procedures has allowed for surgical treatment of some patients in free-standing surgical centers. In this chapter, we review available risk-stratification strategies that can be useful in the preoperative assessment of risk in the obese population undergoing bariatric surgery.

Perioperative Considerations in Liver Transplantation

2018 ◽  
Vol 39 (05) ◽  
pp. 609-624 ◽  
Author(s):  
Roxana Cortes Lopez ◽  
Randolph Steadman ◽  
Christopher Wray ◽  
Nida Qadir ◽  
Steven Y. Chang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Critically Ill ◽  
Preoperative Evaluation ◽  
Hepatopulmonary Syndrome ◽  
Preoperative Assessment ◽  
Postoperative Management ◽  
Critically Ill Patient ◽  
Intraoperative Care ◽  
Intraoperative Management ◽  
Increasing Demand

AbstractLiver transplantation (LT) has the potential to cure patients with acute and chronic liver failure as well as a number of hepatic and biliary malignancies. Over time, due to the increasing demand for organs as well as improvements in the survival of LT recipients, patients awaiting LT have become sicker, and often undergo the procedure while critically ill. This trend has made the process of preoperative assessment and planning, intraoperative management, and postoperative management even more crucial to the success of LT programs. Multidisciplinary and specialized teams are essential and include anesthesiologists, surgeons, and intensivists. This article focuses on the preoperative evaluation, intraoperative care, and postoperative management of the liver transplant patient. Management relevant to the critically ill patient is discussed, with a focus on the management of postoperative cardiopulmonary conditions including the care of special populations such as those with hepatopulmonary syndrome and portopulmonary hypertension.

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