Preoperative Evaluation And Perioperative Medical -Books Pdf

Preoperative Evaluation and Perioperative Medical
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Disclosures,I have no actual or potential conflicts of. interest in relation to this,program presentation,Objectives. Objectives, Understand how to conduct a preoperative medical assessment. medical clearance on the non cardiac surgical patient. Understand the appropriate utilization of preoperative testing. Know how to advise surgeons and patients on perioperative. medical needs i e who needs beta blockers antibiotics etc. Recognize common postoperative complications,Clinical Vignette. Mr Kneeoutawack is a 68 year old man with a,past medical history of hypertension dyslipidemia.
type 2 diabetes mellitus and osteoarthritis of the. right knee who presents to your office at the,request of his orthopedist The patient is. scheduled to undergo right total knee arthroplasty. by Dr Bones in 2 weeks and Dr Bones has asked,that you clear the patient for surgery The. patient will be receiving general anesthesia during. the procedure,Purpose of the Preoperative,Medical Assessment. CLEAR THE PATIENT FOR,Purpose of the Preoperative,Medical Assessment. Determine overall risk of surgery,First do no harm.
Are there other options to solve the patient s problem other than. Determine if additional testing will be needed to establish risk. Make recommendations to both the patient and surgeon on how to. mitigate surgical risk, Medically optimize the patient for the planned procedure. Provide the surgeon with pre and post operative medical. recommendations to ensure the patient will do well. The key to optimal management is,communication among all the relevant parties. i e surgeon anesthesiologist primary caregiver,and consultants and the patient. 2014 ACC AHA Guidelines on Perioperative Cardiovascular. Evaluation and Management of Patients Undergoing Non. cardiac Surgery Executive Summary,Definitions,Emergency Procedure. Life or limb is threatened if not in the operating room typically in less. than 6 hours,Urgent Procedure, Life or limb is threatened if not in the operating room typically between.
6 24 hours,Time sensitive Procedure,A delay of 1 6 weeks can be allowed. Elective Procedure,May be delayed up to one year,Definitions. Low Risk Procedure, Combined surgical and patient characteristics predict a risk of major. adverse cardiac event MACE of death or myocardial infarction MI of. less than 1,Elevated Risk Procedure, Combined surgical and patient characteristics predict a risk of MACE of. death or MI of greater than 1,American Society of Anesthesiologist.
ASA Physical Status Classification,ASA Class 1 Normal healthy. No organic physiologic or psychiatric disturbance,Excludes the very young and very old. ASA Class 2 Patient with mild systemic disease,No functional limitations. Well controlled disease of one body system,Controlled HTN or DM without systemic affects. Cigarette smoking without COPD,Mild obesity,American Society of Anesthesiologist.
ASA Physical Status Classification,ASA Class 3 Patient with severe systemic disease. Some functional limitation, Controlled disease of more than one body system or one major system. No immediate danger of death,Controlled CHF,Stable angina. Poorly controlled HTN,Morbid Obesity,Chronic renal failure. COPD with intermittent symptoms,American Society of Anesthesiologist.
ASA Physical Status Classification, ASA Class 4 patients with severe systemic disease that is constant. threat to life, At least one severe disease that is poorly controlled or end stage. Possible risk of death,Unstable angina,Symptomatic COPD. Symptomatic CHF,Hepatorenal failure, ASA Class 5 Moribund patients not expected to survive more than. 24 hours without the surgery, ASA Class 6 Brain dead patient whose organs are being removed.
for donor purposes,Clinical Risk Factors for,Perioperative Cardiac. Complications,Coronary Artery Disease, Major adverse cardiac events MACE after non cardiac surgery is. often associated with prior CAD events, Postoperative MI and mortality rate decreased as the length of time. between MI and operation increases,0 30 days 32 8 14 2. 31 60 days 18 7 11 5,61 90 days 8 4 10 5,91 180 days 5 9 9 9.
Recent MI less than 6 months prior to operation is an independent. risk factor for perioperative stroke, Associated with 8 fold increase in perioperative mortality.

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