Preoperative Assessment
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Introduction
Cardiovascular Function
Ejection fraction below 35% is a serious contraindication for surgeries noncardiac in nature; perioperative MI rates are over 75%.
Goldman's index of cardiac risk assigns risk points based upon:
- congestive heart failure (worst)
- recent MI
- PVCs
- arrhythmias
- age over 70
- emergency nature of surgery
- aortic valvular stenosis
Respiratory Function
Smoking is the biggest threat to pulmonary function due to impaired ventilation (high pCO2 and low FEV1).
Smoking cessation and respiratory therapy should be strongly encouraged 8 weeks prior to surgery.
Renal Function
Hepatic Function
Mortalilty is increased with increased serum bilirubin or PTT, decreased albumin, or hepatic encaphalopathy.
Metabolic Function
Hyperglycemia must be controlled prior to surgery.
Pre-Operative Letter
The pre-op letter should reflect important characteristics. These include:
- patient identification
- operation details
- past medical history
- history of presenting illness
- perioperative risk factors
- medications
- allergies
- surgical history
- family history
- review of systems
- physical exam
- investigations
- summary
- perioperative risks
Resources and References
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