Books on the topic 'Preoperative medical assessment'
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1
Medical assessment of the elderly surgical patient. Rockville, Md: Aspen Systems Corp., 1986.
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Seymour, Gwyn. Medical assessment of the elderly surgical patient. London: Croom Helm, 1985.
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3
J, McArthur-Rouse Fiona, and Prosser Sylvia, eds. Assessing and managing the acutely ill adult surgical patient. Oxford: Blackwell Pub., 2007.
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4
van Lier, Felix, and Robert Jan Stolker. Preoperative assessment and optimization. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0040.
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Perioperative cardiovascular complications (including myocardial ischaemia and myocardial infarction) are the predominant cause of morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of perioperative myocardial infarction is complex. Prolonged myocardial ischaemia due to the stress of surgery in the presence of a haemodynamically significant coronary lesion, leading to subendocardial ischaemia, and acute coronary artery occlusion after plaque rupture and thrombus formation contribute equally to these devastating events. Perioperative management aims at optimizing the patient’s condition by identification and modification of underlying cardiac risk factors and diseases. The first part of this chapter covers current knowledge on preoperative risk assessment. Current risk indices, the value of additional testing, and new preoperative cardiac risk makers are investigated. During recent decades there has been a shift from the assessment and treatment of the underlying culprit coronary lesion towards a systemic medical therapy aiming at prevention of myocardial oxygen supply–demand mismatch and coronary plaque stabilization. In the second part of this chapter, risk-reduction strategies are discussed, including β-blocker therapy, statins, and aspirins. A central theme in this chapter will focus on long-term cardiovascular risk reduction. Patients who undergo non-cardiac (vascular) surgery are particularly prone to long-term adverse cardiac outcomes. The goal of perioperative cardiovascular risk identification and modification should not be limited to the perioperative period, but should extend well into the postoperative period.
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Aminian, Ali. Online Preoperative Risk Assessment Tools. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0006.
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Despite the presence of robust data on safety and efficacy of bariatric and metabolic surgery, many patients and physicians do not consider surgery to treat obesity, diabetes, and metabolic syndrome. One reason may be inaccurate beliefs about the risk-benefit ratios of medical and surgical treatments of obesity. Estimating the risk of postoperative complications can improve surgical decision-making and informed patient consent. Furthermore, there would be a considerable benefit in identifying modifiable preoperative conditions that are associated with increased risk of postoperative adverse events. The methodology and characteristics of online risk assessment tools in bariatric surgery are presented in this chapter.
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Ignatavicius, Donna D. Medical-Surgical Nursing - Single Volume - Text with FREE Study Guide and Virtual Clinical Excursions 3. 0 Package. Elsevier - Health Sciences Division, 2008.
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Cetin, Derrick. Medical Evaluation of the Bariatric Surgery Patient. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0002.
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Evaluation of the obese patient requires identification of all comorbidities and health conditions, including underlying cardiac and pulmonary conditions that could have a negative outcome on noncardiac surgery. Once comorbidities have been recognized, aggressive optimization of these medical conditions can provide improved outcomes after bariatric surgery. Estimating medical risk can be performed by several validated classification systems. The preoperative checklist and clinical practice guidelines (CPG) were updated in 2013. The CPG recommendations for preoperative evaluation of the bariatric surgery patient include lab testing, nutritional screening, endocrine assessment, and cardiopulmonary assessment, including sleep apnea screening. The CPG suggest an extensive multidisciplinary team approach to the preoperative bariatric surgery patient. Finally, the medical evaluation includes an algorithm for a seven-step approach to the preoperative visit. Also recommended for evaluation of the morbidly obese patient is an algorithm that uses a five-step approach after a comprehensive history and physical exam and lab testing.
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Beg, Yasmeen, and BobbieJean Sweitzer. Preoperative Patient Evaluation for Anesthesia Care Outside of the Operating Room. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190495756.003.0002.
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Increasing numbers of patients with serious comorbidities undergo procedures that require anesthesia services outside of the operating room (OOOR). A general anesthetic requiring instrumentation of the airway may pose a greater risk than many procedures performed in OOOR settings. A thorough review of the patient’s history and medical records should be undertaken as part of the preanesthetic assessment. Preprocedure testing is often unnecessary unless there is a medical indication or the results will alter management. The patient’s comorbidities and the nature of the procedure are considered when managing medications. Preparation to lower the risk of complications and improve outcomes during and after procedures requiring anesthesia is the most important goal. Identification and modification of risk are essential. As the numbers of patients having anesthesia in OOOR locations increase, anesthesiologists must continue to innovate to provide patients with the best preoperative services.
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DeMaria, Eric J., and Claudia Jin Kim. Evaluating Bariatric Surgical Risk Using Risk-Scoring Systems. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0004.
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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.
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Abatzis, Vaia T., and Edward C. Nemergut. Transsphenoidal/Pituitary Surgery. Edited by David E. Traul and Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0004.
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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.
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Freely Jr, John J., and Michel Sabbagh. Pyloric Stenosis. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0083.
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Pyloric stenosis is one of the most common surgical conditions affecting neonates and young infants. Hypertrophy of the pyloric muscular layers results in gradual gastric outlet obstruction. Persistent episodic projectile vomiting and dehydration as well as hypochloremic, hypokalemic metabolic alkalosis are cardinal features. Definitive treatment is surgical pyloromyotomy, but it is not a surgical emergency. Emergency medical intervention is often required to correct intravascular volume depletion and electrolyte disturbances. Morbidity and mortality should be limited due to advancements in surgical and perioperative care. Morbidity can occur due to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript is a review of current evidence-based perioperative care of infants with pyloric stenosis. It reviews the pathophysiology that results in metabolic disturbances and intravascular volume depletion. It focuses on preoperative assessment and correction of electrolyte abnormalities and anesthetic technique including airway management and postoperative analgesia.
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Jakobsson, Jan. Anaesthesia for day-stay surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0068.
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Day-stay surgery is becoming increasingly common the world over. There are several benefits of avoiding in-hospital care. Early ambulation reduces the risk for thromboembolic events, facilitates wound healing, and avoiding admission reduces the risk for hospital-related infection. Additionally, the risk of neurocognitive side-effects can be avoided by returning the elderly patient to their home environment. Day-stay anaesthesia calls for adequate and structured preoperative assessment and patient evaluation, and the potential risk associated with surgery and anaesthesia should be assessed on an individual basis. Need for preoperative testing should be based on functional status of the patient and preoperative medical history but even the surgical procedure should be taken into account. Preoperative fasting should be in accordance with modern guidelines, refraining from food for 6 hours and fluids for 2 hours prior to induction in low-risk patients. Preventive analgesia and prophylaxis of postoperative nausea and vomiting (PONV) should be administered preoperatively. Local anaesthesia should be administered prior to incision, constituting part of multimodal analgesia. The multimodal analgesia strategy should also include paracetamol and a non-steroidal anti-inflammatory drug in order to reduce the noxious stimulus from the surgical field. Third-generation inhaled anaesthetics or a propofol-based maintenance are both feasible alternatives. Titrating depth of anaesthesia by using an EEG-based depth of anaesthesia monitor may facilitate the recovery process. The laryngeal mask airway has become commonly used and has several advantages. Ultrasound-guided peripheral blocks may facilitate the early postoperative course by reducing pain and avoiding the use of opiates. Perineural catheters may be an option for prolongation of the block following painful orthopaedic procedures but a strict protocol and follow-up must be secured. Not only pain but even nausea and vomiting should be prevented, and therefore risk stratification, for example by the Apfel score, and PONV prophylaxis in accordance with the risk score is strongly recommended. Early ambulation should be encouraged postoperatively. Safe discharge should include an escort who also remains at home during the first postoperative night. Analgesics should be provided and be readily available for self-care when the patient comes home. Pain medication should include an opioid; however, the benefit versus risk must be assessed on an individual basis. Patients should also be instructed about a rescue return-to-hospital plan. Quality of care should include follow-up and analysis of clinical practice, and institution of methods to improve quality should be enforced for the benefit of the ambulatory surgical patient.
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Roberts, Steve, ed. Paediatric Anaesthesia. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198755791.001.0001.
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Paediatric Anaesthesia is a comprehensive yet concise text covering everything from day surgery to complicated tertiary referral centre procedures. It provides concise and readily accessible information to trainee and expert alike. The book begins with the basic sciences and founding principles of anaesthetic management; containing simple tips on how to approach the perioperative care of children. Thereafter, each specialty is covered in a logical manner from preoperative assessment to post-operative care. Finally, the book covers paediatric medical emergencies, resuscitation and transfer of the child. This second edition has been uniformly updated and written by leading authorities from across the UK.
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Thompson, Jonathan P. Anaesthesia for vascular surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0058.
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Vascular surgical patients are at higher risk of cardiovascular morbidity and mortality than other surgical patients, and perioperative care remains challenging. However, vascular surgical practice is changing, with the expanding use of endovascular techniques to treat patients with vascular disease, improvements in medical therapy, and the evolution of evidence-based approaches to preoperative assessment. Preoperative assessment should concentrate on identifying and optimizing potentially correctable medical conditions, in particular cardiovascular disease. Successful outcomes depend on good anaesthetic techniques with emphasis on meticulous attention to detail and maintaining cardiovascular function and stability. Good communication with surgical and radiological colleagues is also vital. Anaesthesia for major vascular surgery also requires expertise in managing major haemorrhage, the use of invasive monitoring and cardioactive drugs, and regional anaesthesia. Knowledge and skills in the use of specific techniques for monitoring and protection against organ dysfunction are required. Endovascular surgery may be performed in dedicated operating suites or within the radiology department so the anaesthetist needs to be aware of considerations for anaesthesia in an isolated environment. This chapter details the management of patients presenting for the commonest major vascular procedures. All aspects of perioperative care for patients with abdominal and thoracic aortic aneurysms, occlusive aortic and peripheral vascular disease, and carotid stenosis are discussed. Anaesthesia for open surgery, endovascular and hybrid procedures, and elective and emergency procedures are included. The benefits of regional and general anaesthetic techniques are considered, where appropriate. The chapter also incorporates the anaesthetic management for less common procedures to treat carotid body tumours, thoracic outlet syndrome, and for thoracoscopic sympathectomy.
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Agarwal, Anil, Neil Borley, and Greg McLatchie, eds. Oxford Handbook of Operative Surgery. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199608911.001.0001.
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The Oxford Handbook of Operative Surgery (OHOS) is for surgical trainees in their early years of training. Medical students and nurses will also find it useful. It follows the Intercollegiate Surgical Curriculum Programme syllabus. The format is indications, anatomy, procedure, post-operative complications, tips and tricks. Numerous illustrations are used throughout the book. The general surgery chapter covers preoperative assessment, consent, antibiotics prophylaxis, and venous thromboembolism, WHO checklist, energy devices used in operations, duty of candour, sutures, meshes, hernia repair. All the specialties are covered. These are upper gastrointestinal, hepatobiliary pancreatic, colorectal, breast, endocrine, paediatric, vascular, transplantation, urology, plastic and reconstructive, cardiothoracic, neurosurgery, ENT, oral and maxillofacial, and orthopaedics surgery.
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Chen, Martin, and Muoi Trinh. Cardiogenic Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0010.
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Heart failure and cardiogenic shock are important causes of perioperative morbidity and mortality that require prompt recognition prior to the institution of specialized monitoring and treatment, including the consideration of circulatory assist devices. Patients at risk for perioperative heart failure require special consideration with respect to preoperative evaluation, medical optimization prior to proceeding with surgery, and monitoring throughout the perioperative period. The intraoperative and postoperative management need to be carefully planned in order to avoid the development of acute decompensated heart failure and cardiogenic shock. This chapter reviews the perioperative assessment and management of heart failure patients as well as the management of perioperative cardiogenic shock.
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Prentice, Elizabeth. Laryngeal Papillomatosis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0018.
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The incidence of recurrent juvenile laryngeal papilloma caused by human papilloma virus has been rising (Dalmeida et al., 1996). A child with this potentially life-threatening condition requires surgical resection to avoid respiratory obstruction; this surgery may need to be repeated regularly for many years. Laser therapy to the airway provides specific challenges to the anesthesiologist. In particular, the risks of a shared compromised airway as well as the hazards of the laser itself must be appreciated by all medical personnel. The key to success is thorough preoperative assessment, good continuous communication with surgical and nursing staff, preparation for the management of critical incidents, and familiarity with the surgical and anesthetic equipment.
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Rogula, Tomasz G., Philip R. Schauer, and Tammy Fouse, eds. Prevention and Management of Complications in Bariatric Surgery. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.001.0001.
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This book focuses on prevention and management of complications in bariatric surgery. The book will serve as a practical guide for healthcare providers, including bariatric and general surgeons, primary care physicians, nurse practitioners, cardiologists, gastroenterologists, anesthesiologists, psychologists, and dietitians. Chapters describing surgical management of complications should be of special interest to emergency department doctors and surgeons. The book covers most aspects of typical and atypical problems and can be used as a study guide for fellows, residents, and medical students. The text provides a comprehensive overview in four sections: 1. Standards and guidelines for perioperative care of the bariatric patient. 2. Perioperative complications. 3. Procedure-specific complications. 4. Economic and legal considerations. The 40 chapters were written by top experts in bariatric and metabolic surgery, including the faculty of the renowned Cleveland Clinic. Many chapters include high-quality illustrations and surgical case photographs. The discussions emphasize preoperative risk optimization, medical and psychological evaluation, and risk-scoring systems, including preoperative risk assessment tools developed as a result of extensive research involving thousands of patients. Attention is paid to very-high-risk patients undergoing bariatric surgery. A special section includes guidelines for appropriate operating room set-up as well as for anesthesia and recovery issues. Management of intestinal failure after bariatric surgery, including intestinal transplantation, is a unique contribution of this book. Common, historical, and new bariatric procedures are described in detail from the perspective of management of their specific complications. Postoperative complications, including infection, thromboembolism, nutritional deficiencies, and endocrinologic problems are addressed. Practical guidelines for medicolegal issues are also presented.
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Elwes, Robert. Presurgical evaluation for epilepsy surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0031.
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This chapter describes the preoperative electroclinical assessment of the various epilepsy syndromes and pathologies that are open to surgical treatment. Particular emphasis is placed on medial temporal epilepsy and frontal epilepsy. The assessment of cases considered for hemispherotomy, multiple subpial transection for Landau–Kleffner syndrome, anterior two-thirds callosotomy in symptomatic generalized epilepsy, neural stimulation, and cases with nodular hetertopia are summarized. Throughout the chapter, particular emphasis is placed on the need for multidisciplinary assessment, and the interpretation of the electroencephalogram (EEG) in the context of the clinical features, imaging, and neuropsychology. Evaluation pathways are suggested and the indications for intracranial EEG, the types of electrodes used and the operative complications are discussed in detail. Summaries of the key points in the electroclinical evaluation of temporal and frontal lobe epilepsy are given.