Preoperative and Intraoperative Care

Published on 11/04/2015 by admin

Filed under Surgery

Last modified 11/04/2015

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CHAPTER 1 Preoperative and Intraoperative Care

PREOPERATIVE CARE

Indications for surgery must be weighed against the risks associated with the planned procedure. Principles that guide this evaluation and preoperative planning are the subject of the first part of this chapter.

Additional Considerations

An aging population and advances in perioperative care with associated improvements in outcomes have lessened the number of absolute contraindications to surgical intervention. Patients with significant comorbidities, however, require a more extensive preoperative evaluation and, sometimes, preoperative interventions. Cardiovascular disease and pulmonary disease in particular often mandate special preoperative consideration.

I. Cardiovascular Disease

A. Approximately 30% of surgical patients have cardiac disease. A number of risk stratification tools (e.g., the Cardiac Risk Index and American College of Cardiology/American Heart Association [ACC/AHA] Guidelines) are in use and take into account various clinical predictors, functional status, and planned procedure type to identify those patients who will benefit from a more extensive cardiac evaluation (Fig. 1-1). The preoperative history and physical examination should elicit signs and symptoms of coronary artery disease, valvular disease, congestive heart failure (CHF), and cardiac arrhythmias. Patients who have suffered from a recent MI (within 6 months) are at a substantially elevated risk for a perioperative MI. The timing of surgery for these patients must be given special consideration because this risk lessens with time.