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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...