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Cardiovascular disease Perioperative cardiovascular complications are frequent. Patients who can climb a flight of stairs without getting short - of breath, having chest pain or needing to stop are likely to tolerate a wide range of surgeries with an accepta...

Cerebral vascular disease Patients who have su ff ered a cerebrovascular accident have been shown to have a higher rate of MACE postoperatively . This is highest in the first 3 months after a stroke. The urgency of surgery needs to be discussed with the surgeo...

Choosing the right operation for the high-risk patient There are situations in which the selection of one surgical technique over another may be significantly influenced by patient risk factors. Some procedures are not primarily high risk but may become so in u...

Drug-eluting coronary stents (DES) Primary percutaneous intervention is the treatment of choice for acute coronary syndromes, and many patients receive stents and are on dual antiplatelet therapy for 12 months. If surgery is absolutely necessary within the pe...

Dysrhythmias In patients with atrial fibrillation (AF), β -blockers, digoxin or calcium channel blockers should be continued in order to control rate. New AF or atrial flutter should be investigated and treated. These patients should be considered for cardiovers...

EMERGENCY SURGERY In emergency surgery the principles of preoperative assessment should be the same as in elective surgery , except that the opportunity to optimise the condition of the patient is limited by time constraints. The urgency of surgery should b...

Endocrine and metabolic disorders Malnutrition Body mass index (BMI) is weight in kilograms divided by height in metres squared. A BMI of less than 18.5 indicates nutritional impairment and a BMI below 15 is associated with Thomas Addison , 1795–1860, physici...

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...