Preparation for surgery

Preparation for surgery

Clinical assessment Before CABG, the severity and stability of the patient’s IHD, the presence of significant valvular disease and the status of left ventricular function should be properly evaluated. Any comorbid risk factors for IHD should be documented and, in particular, the state of coexisting diseases assessed. Attention is paid to the presence of carotid artery disease, peripheral vascu lar disease, respiratory status, preoperative diabetic control and presence of associated diabetic complications, significant renal dysfunction or coagulopathy . All medications taken by Edgar Van Nuys Allen , 1900–1961, Professor of Medicine, Mayo Clinic, Rochester, MN, USA. - surgery (e.g. antiplatelet agents, including aspirin; anticoag - - ulants; and oral hypoglycaemics). Others, including diuretics and angiotensin-converting enzyme inhibitor s, are stopped at the discretion of the surgeon. Cardiac and antihypertensive medications should be taken preoperatively . Risk assessment Myocardial revascularisation by CABG is appropriate when the expected benefits (i.e. survival or health outcomes) exceed the expected negative consequences of the procedure. There - fore, objective methods for risk assessment are essential to determine the patient’s suitability for surgery and to provide patients with adequate information for informed consent. V arious scoring systems have been developed for risk strati - - fication in cardiac surgery , including the EuroSCORE II and the Society of Thoracic Surgeons (STS) score. EuroSCORE II is the system most commonly used in the UK and takes into account di ff erent factors such as age and gender, coexisting conditions such as diabetes and peripheral vascular disease and the proposed operation. -