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Examination Patients should be treated with respect and dignity , receive a clear explanation of the examination undertaken and be kept as comfortable as possible. A chaperone should be present, especially for intimate examinations. This should be part of a ...

FURTHER READING Bainbridge D, Martin J, Arango M, Cheng D; for the Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-anal...

Factors contributing to risk Risk is a complex interaction of multiple factors that can be classified into patient and surgical factors. Patient factors are listed in Table 21.6 . The elderly , although not independently at higher risk, not only have more card...

Gastrointestinal disease Regurgitation risk Patients undergoing general anaesthesia or sedation have - a risk of regurgitation of stomach contents and aspiration pneumonia. To reduce this risk patients should fast preoperatively . This should be clearly expl...

Genitourinary disease Renal failure Underlying conditions leading to chronic renal failure such as diabetes mellitus, hypertension and IHD should be stabilised before elective surgery . Appropriate measures should be taken to treat acidosis, hypocalcaemia and ...

Heart failure Left ventricular failure is the end result of several conditions, including IHD, hypertension, cardiomyopathies and valve dysfunction. Decompensated heart failure puts the patient at risk of multiorgan failure. Those with ejection fractions of ...

Hypertension Prior to elective surgery blood pressure should be controlled to <160/100 /uni00A0 mmHg. If a new antihypertensive agent is introduced, a stabilisation period of at least 2 weeks should be allowed. Hypertension Prior to elective surgery blood pr...

Implanted pacemakers and cardiac defibrillators Checks and appropriate reprogramming should be done preoperatively by specialists and advice followed. Monopolar diathermy activity during surgery may be sensed by the pace maker as ventricular fibrillation or a pa...

INTRODUCTION The stress of major surgery can lead to increased oxygen demand by up to 40%. Inflammatory changes due to cytokine release, endocrine responses, hypercoagulability and redistribution of fluid between compartments may last several postoperative day...

Investigations Guidelines produced by the UK’s National Institute for Health and Care Excellence (NICE) set out the investigations needed for various categories of elective surgery and American Society of Anesthesiologists (ASA) score of the patient. The fo...

Ischaemic heart disease Patients with angina that is not well controlled should be inves - tigated further by a cardiologist. The indications for coronary - revascularisation in patients awaiting surgery are the same as at any other time. Pharmacological prote...

Learning objectives To understand preoperative preparation for surgery: Surgical, medical and anaesthetic aspects of assessment • How to optimise patients and identify those at • higher risk Learning objectives To understand preoperative preparation for surger...

Musculoskeletal disorders Muscular disorders have serious implications and require a tailored anaesthetic approach. They include muscular dystrophies, myotonic dystrophy and myasthenia gravis and a personal or family history of malignant hyperpyrexia. Rheumat...

Neurological and psychiatric disorders Anticonvulsants and anti-Parkinson’s medication must be continued perioperatively to help early mobilisation of the patient, and patients should be planned early on a theatre list to reduce starvation times. Parenteral m...

PATIENT ASSESSMENT History taking A thorough past medical history , surgical history and systemic enquiry should be documented, including important negatives ( Table 21.1 ). The history of past surgery and anaesthetic events can reveal the problems one may fa...

PHYSICAL FITNESS Functional physical fitness can be judged by the ability to tolerate metabolic equivalent tasks (METs) ( Table 21.5 ). One MET is equivalent to the oxygen consumption of an adult at rest (~3.5 /uni00A0 mL/kg/min). Di ff erent tasks are assigned...

Respiratory disease Postoperative respiratory complications, such as pneumonia, are a major cause of morbidity and mortality , especially after major abdominal and thoracic surgery . A patient’s current respiratory status should be compared with their ‘normal ...

Risk prediction The key to managing patients e ff ectively is the identification and accurate quantification of the risk, and subsequent measures taken to minimise it. Realistic estimates of risk are the cornerstone of informed patient consent and shared decis...