Preoperative medical consultation

Cover......Page 1
Preface......Page 2
General principles of medical consultation......Page 4
Answering the question......Page 5
Improving compliance......Page 6
References......Page 8
Normal and abnormal test results......Page 10
Rationale for preoperative testing......Page 11
Hemoglobin......Page 12
Platelet count......Page 13
Coagulation tests......Page 17
Electrolytes......Page 20
Renal function tests......Page 22
Serum glucose......Page 25
Urinalysis......Page 27
Electrocardiogram......Page 29
Chest radiograph......Page 31
Recommendations......Page 37
References......Page 39
Perioperative medication management......Page 44
Cardiac drugs......Page 45
Pulmonary drugs......Page 46
Antiplatelet agents and anticoagulants......Page 47
Osteoporosis agents......Page 49
Herbal remedies......Page 51
Antiparkinsonian agents......Page 52
Antidepressants......Page 53
Selective serotonin reuptake inhibitors......Page 54
Mood stabilizers......Page 55
Thyroid......Page 56
Adrenal gland......Page 57
Rheumatologic drugs......Page 58
References......Page 59
Postoperative infections......Page 61
Nonantimicrobial strategies for reducing postoperative infection......Page 62
Principles of perioperative antimicrobial use......Page 63
Duration of antibiotic prophylaxis after surgery......Page 64
Gynecologic and obstetric......Page 65
Orthopedic procedures......Page 68
The rationale for antimicrobial prophylaxis......Page 69
At risk procedures......Page 70
Summary......Page 72
References......Page 74
Scope of the problem......Page 78
Interpreting the literature......Page 79
Age......Page 80
Presence of a thrombophilic disorder......Page 81
Immobilization-stasis......Page 82
Risk stratification......Page 83
Early ambulation......Page 84
Intermittent pneumatic compression devices......Page 86
Efficacy......Page 88
Aspirin......Page 89
Warfarin......Page 90
Available drugs......Page 91
Safety......Page 92
Epidural catheters......Page 93
Timing of prophylaxis......Page 94
Orthopedic surgery......Page 95
Role of screening for asymptomatic VTE......Page 96
Bleeding risk......Page 97
Patient considerations......Page 98
Venous thromboembolism and atrial fibrillation......Page 99
Mechanical prosthetic heart valves......Page 100
Bridging therapy with low molecular weight heparins......Page 101
Recommending and implementing a postoperative thromboprophylaxis regimen......Page 102
References......Page 103
Preoperative risk evaluation and perioperative management of patients with coronary artery disease......Page 112
Overview of cardiac risk indices......Page 113
History......Page 117
Previous cardiac work-up......Page 119
ACC-AHA guidelines......Page 120
Our recommendations......Page 123
Resting echocardiography......Page 124
Non-exercise stress testing......Page 125
Dobutamine stress echocardiography......Page 126
Medical therapy......Page 127
Beta-blockers......Page 128
Preoperative coronary artery bypass grafting......Page 129
Percutaneous coronary intervention......Page 130
Pulmonary artery catheters......Page 131
Our approach......Page 132
Summary......Page 133
References......Page 134
History......Page 138
Laboratory data......Page 139
Prevalence and risk factors......Page 140
Treatment......Page 141
Treatment......Page 142
Cardiomyopathy......Page 143
Epidemiology and clinical significance......Page 144
Management......Page 146
Implanted pacemakers and ICDs......Page 147
Valvular heart disease......Page 148
References......Page 150
Preoperative evaluation for postoperative pulmonary complications......Page 154
Literature search and identification strategy......Page 155
General health and nutritional status......Page 156
Neurologic status......Page 157
Surgical incision site and type of surgery......Page 158
Surgical technique......Page 160
Route and type of anesthesia administration......Page 161
Risk factors related to postoperative care......Page 162
Risk indices for preoperative assessment......Page 163
Pulmonary function testing......Page 164
Preoperative smoking cessation......Page 166
Perioperative lung expansion maneuvers......Page 167
References......Page 170
Diabetes mellitus and surgery......Page 175
Ramifications of perioperative hyperglycemia......Page 176
Preoperative evaluation......Page 177
Management of diabetes during surgery......Page 178
IV insulin and glucose infusion......Page 179
Diabetes therapy after surgery......Page 180
Surgery in the hypothyroid patient......Page 181
Surgery in the patient with hyperthyroidism......Page 182
Perioperative management of the patient with pheochromocytoma......Page 183
Preoperative preparation......Page 184
Suppression of the HPA axis......Page 186
Supplemental glucocorticoid regimens......Page 187
References......Page 189
Perioperative care of the patient with renal failure......Page 193
Pathophysiology......Page 194
Clinical and laboratory evaluation......Page 195
Prevention of postoperative acute renal failure......Page 196
Clinical and laboratory evaluation......Page 199
Cardiac evaluation......Page 200
Fluid and electrolyte management......Page 202
Anemia and bleeding diathesis......Page 203
Drug therapy......Page 204
Glycemic control......Page 205
References......Page 206
Asymptomatic patients......Page 211
Acute and chronic hepatitis......Page 212
Cirrhosis......Page 213
Improved outcomes in laparoscopic procedures......Page 217
Hepatic resection......Page 218
Obstructive jaundice......Page 220
Summary......Page 221
References......Page 223
The preoperative evaluation of the anemic patient......Page 228
Physiologic changes associated with anemia......Page 229
Evidence pertaining to transfusion in the perioperative setting......Page 230
Transfusion in patients with cardiovascular disease......Page 231
Autologous blood transfusion......Page 232
Guidelines for transfusion......Page 233
Preoperative testing......Page 234
Management of patients with known coagulopathies......Page 235
Thrombocytopenia......Page 237
Summary......Page 238
References......Page 239
Perioperative issues in patients with cancer......Page 242
Pain......Page 243
Cardiopulmonary considerations......Page 244
Endocrine and metabolic......Page 245
Hematologic considerations......Page 246
Granulocytosis......Page 247
Chemotherapy......Page 248
Hepatotoxicity......Page 249
Adrenal insufficiency......Page 250
Radiation therapy......Page 251
Summary......Page 252
References......Page 253
Cerebrovascular disease......Page 256
Preoperative evaluation of carotid bruits......Page 257
Dementia......Page 258
Seizure disorders......Page 259
Carotid endarterectomy......Page 260
SAH and aneurysm......Page 262
Medical evaluation before surgery for brain tumors......Page 263
DVT prophylaxis......Page 264
Hypertension......Page 265
Postoperative delirium......Page 266
Hyponatremia......Page 267
Summary......Page 268
References......Page 269
Perioperative care for the elderly patient......Page 271
Demographics......Page 272
Cardiac......Page 273
Laboratory abnormalities......Page 274
Delirium......Page 275
Immobility......Page 277
Malnutrition......Page 278
Outcomes of surgery in the elderly......Page 279
The do-not-resuscitate status in the perioperative setting......Page 283
References......Page 284
Selected Readings......Page 286