Search Results

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...

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...