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CURRENT Medical Diagnosis & Treatment 2013
Chapter 3. Preoperative Evaluation & Perioperative Management
Sections: Preoperative Evaluation & Perioperative Management: Introduction, Evaluation of the Asymptomatic Patient, Cardiac Risk Assessment & Reduction, Pulmonary Evaluation in Non–Lung Resection Surgery, Evaluation of the Patient with Liver Disease, Preoperative Hematologic Evaluation, Neurologic Evaluation, Management of Endocrine Diseases, Kidney Disease, Antibiotic Prophylaxis of Surgical Site Infections.
Topics Discussed: preoperative medical evaluation.
Excerpt:"Each year, tens of millions of patients in the United States undergo a surgical procedure requiring general or spinal-epidural anesthesia. An increasing number of these patients are over age 65 or have significant comorbid medical disease. However, operative mortality and morbidity have declined over the past three decades due to improvements in surgical, anesthetic, and monitoring techniques. Cardiac, pulmonary, infectious, and neurologic complications account for most of the perioperative morbidity and mortality. The traditional preoperative roles of the medical consultant include evaluating the severity and stability of the patient’s medical conditions, assessing the risk of medical complications, and recommending measures to reduce the risk of perioperative complications. The consultant may also be asked to manage medical aspects of patients’ postoperative care. In general, decisions about anesthetic techniques and agents, intraoperative monitoring, and other aspects of care within the operating room should be left to the anesthesiologist. However, the medical consultant should understand the physiologic effects of anesthesia and surgery. Both general and regional (spinal or epidural) anesthetic agents usually cause peripheral vasodilatation, and many of the commonly..."
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