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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.

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

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...

Role of critical care and outreach services Reports from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) show that the majority of postoperative deaths in the UK occur more than 5 days after surgery . Admission to a critical care unit...

Valvular heart disease While anaesthetic management is altered to achieve haemo dynamic stability in moderate valvular diseases, patients with severe aortic and mitral stenosis may benefit from valvuloplasty before elective non-cardiac surgery . Appropriate ref...

Admission and list planning Day surgery patients should follow the same starvation guidance as any other elective patient. All patients, but especially day surgery patients, should be encouraged to walk to theatre. Consider the list order to optimise successfu...