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Baseline
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· The overall risk of surgery is low in healthy patients
· Screening is not indicated unless there is a clinical indication
Baseline tests
· complete blood count
o > 65 years of age undergoing major surgery
o younger patients undergoing surgery expected to have significant blood loss
· serum creatinine
o > 50 years of age undergoing > intermediate risk surgery
o renal disease
· pregnancy test
o all women in their reproductive age
· electrocardiogram (ECG)
o coronary artery disease
o arrhythmias
o peripheral artery disease
o cerebrovascular disease
o structural heart disease
· chest radiograph
o underlying cardiac or pulmonary disease
o abdominal or thoracic surgery
· obesity
o increased risk of pulmonary complications
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CVS
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o If CHF + Fluid overload (EF <35) –> no surgery
o If MI –> wait for 6 m
· risk w/i 3 m is 40%
· if you cant delay, admit to ICE 1 day pre-op
o Dx: ECG / Echo
o Goldman index: remains useful for listing all the findings that predict trouble. They are (in descending order of importance):
· jugular venous distension,
· recent myocardial infarction,
· premature ventricular contractions or any rhythm other than sinus,
· age over 70,
· emergency surgery,
· aortic valvular stenosis,
· poor medical condition,
· and surgery within the chest or abdomen.
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Lungs
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o Ventilation > Oxygenation
o Pt: smokers, COPD/Asthma, ILD
o Dx: PFT (@ day of surgery: ABG)
· obtain older PFT –(if FEV1 is abnormal)–> obtain an ABG
o Tx: Give O2 – if pt has underlying condition (Inhalers)
o Smoking cessation! (8 weeks before surgery)
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Liver
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o Check liver synthetic function: Albumin – CFs – T Bili
o Sx: Ascites / encephalopathy
o Child class, in which class A has 10% mortality, class B 30%, and class C 80%.
o Tx: Liver transplant
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Renal
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if pt needs dialysis –> do it 24h prior to surgery
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