BOOK
Preoperative Evaluation, An Issue of Anesthesiology Clinics, E-Book
Debra Domino Pulley | Deborah C. Richman
(2016)
Additional Information
Book Details
Abstract
This issue of Anesthesiology Clinics focuses on Preoperative Evaluation.Topics will include: Preoperative Clinics, Consultations,Informed Consent/Shared Decision Making, Preoperative Labs,Evaluation of Major Organ Systems, Special Considerations, and Innovative treatment/preparation programs
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Preoperative Evaluation | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Preoperative Evaluation—Can We Really Make a Difference in Outcomes?\r | vii | ||
| Preface: Preoperative Evaluation\r | vii | ||
| I: Introductory Articles | vii | ||
| Preoperative Clinics\r | vii | ||
| Preoperative Consultations\r | vii | ||
| Perioperative Ethical Issues\r | vii | ||
| Preoperative Laboratory Testing\r | viii | ||
| SUMMARY | 237 | ||
| II: Evaluation of Major Organ Systems | viii | ||
| Preoperative Assessment of the Patient with Cardiac Disease Undergoing Noncardiac Surgery59 | viii | ||
| Preoperative Evaluation: Estimation of Pulmonary Risk\r | viii | ||
| Stratification and Risk Reduction of Perioperative Acute Kidney Injury\r | ix | ||
| Perioperative Approach to Anticoagulants and Hematologic Disorders\r | ix | ||
| III: Innovative Treatment / Preparation Programs | ix | ||
| Preoperative Anemia: Evaluation and Treatment\r | ix | ||
| Preoperative Nutrition and Prehabilitation\r | ix | ||
| IV: Special Considerations | x | ||
| Preoperative Evaluation of Patients with Diabetes Mellitus155 | x | ||
| Preoperative Assessment of Geriatric Patients\r | x | ||
| Implantable Devices: Assessment and Perioperative Management\r | x | ||
| Preoperative Evaluation of the Patient with Substance Use Disorder and Perioperative Considerations\r | x | ||
| The Pregnant Patient: Assessment and Perioperative Management\r | xi | ||
| Non-operating Room Anesthesia: The Principles of Patient Assessment and Preparation\r | xi | ||
| ANESTHESIOLOGY CLINICS \r | xii | ||
| FORTHCOMING ISSUES | xii | ||
| June 2016 | xii | ||
| September 2016 | xii | ||
| December 2016 | xii | ||
| RECENT ISSUES | xii | ||
| December 2015 | xii | ||
| September 2015 | xii | ||
| June 2015 | xii | ||
| Foreword:\r\rPreoperative Evaluation—Can\rWe Really Make a Difference in\rOutcomes? | xiii | ||
| Preface:Preoperative \rEvaluation | xv | ||
| REFERENCES | xvi | ||
| Introductory Articles | H1 | ||
| Preoperative Clinics | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| HISTORY/BACKGROUND | 2 | ||
| BENEFITS AND OUTCOMES | 4 | ||
| DEVELOPING PREOPERATIVE PROGRAMS | 5 | ||
| Vision and Goals | 5 | ||
| SCOPE | 6 | ||
| TACTICAL AND OPERATIONAL PLANS | 7 | ||
| SPECIFIC SERVICES DELIVERED | 8 | ||
| Triage | 8 | ||
| Phone Calls | 9 | ||
| In-person Clinic Visits | 9 | ||
| Algorithms | 9 | ||
| Communication | 9 | ||
| IDENTIFYING RESOURCES | 9 | ||
| Workforce | 9 | ||
| Visit Volumes and Space | 10 | ||
| Financial Resources | 12 | ||
| Performance Management/Quality Improvement | 12 | ||
| SUMMARY | 12 | ||
| REFERENCES | 13 | ||
| Preoperative Consultations | 17 | ||
| Key points | 17 | ||
| INTRODUCTION | 17 | ||
| THE PURPOSE OF CONSULTATION | 18 | ||
| CURRENT USE OF PREOPERATIVE MEDICAL CONSULTATIONS | 19 | ||
| THE COST OF PREOPERATIVE MEDICAL CONSULTATIONS | 23 | ||
| COORDINATION OF PERIOPERATIVE CARE | 24 | ||
| MEDICOLEGAL ASPECTS | 25 | ||
| OUTCOMES AND PREOPERATIVE MEDICAL CONSULTATIONS | 26 | ||
| RECOMMENDATIONS | 28 | ||
| SUMMARY | 30 | ||
| REFERENCES | 30 | ||
| Perioperative Ethical Issues | 35 | ||
| Key points | 35 | ||
| SHARED DECISION-MAKING | 35 | ||
| Introduction | 35 | ||
| Ethical Issues | 36 | ||
| Affordable Care Act | 36 | ||
| Evidence for Shared Decision-Making Preoperatively | 36 | ||
| Barriers and Motivators | 37 | ||
| Barriers to Shared Decision-Making | 37 | ||
| Motivators for Shared Decision-Making | 37 | ||
| Summary | 37 | ||
| DO NOT RESUSCITATE IN THE OPERATING ROOM | 38 | ||
| Introduction | 38 | ||
| How Does One Reconcile These Two Perspectives? | 38 | ||
| Biomedical ethical principles and Do Not Resuscitate | 39 | ||
| Autonomy | 39 | ||
| Beneficence | 39 | ||
| Nonmaleficence | 39 | ||
| Justice/fairness | 39 | ||
| Who Is Responsible to Discuss and Clarify Do-Not-Resuscitate Orders During the Perioperative Period? | 40 | ||
| Summary | 41 | ||
| REFERENCES | 41 | ||
| Preoperative Laboratory Testing | 43 | ||
| Key points | 43 | ||
| TEST GRID STUDIES | 45 | ||
| ROLE OF AGE | 46 | ||
| ELECTROCARDIOGRAM | 46 | ||
| HIGHLY SENSITIVE TROPONIN | 48 | ||
| NATRIURETIC PEPTIDES | 48 | ||
| RENAL FUNCTION TESTING | 49 | ||
| PREOPERATIVE URINE ANALYSES | 50 | ||
| PREOPERATIVE PREGNANCY TESTING | 50 | ||
| TESTING FOR BLOOD GLUCOSE AND GLYCATED HEMOGLOBIN | 51 | ||
| HEMATOCRIT | 52 | ||
| COAGULATION STUDIES | 52 | ||
| GENETIC TESTING | 53 | ||
| SUMMARY | 53 | ||
| REFERENCES | 54 | ||
| Evaluation of Major Organ Systems | H3 | ||
| Preoperative Assessment of the Patient with Cardiac Disease Undergoing Noncardiac Surgery | 59 | ||
| Key points | 59 | ||
| CLINICAL ASSESSMENT | 60 | ||
| IMPORTANCE OF THE OPERATIVE PROCEDURE | 63 | ||
| IMPORTANCE OF EXERCISE TOLERANCE | 63 | ||
| APPROACH TO THE PATIENT | 64 | ||
| CHOICE OF DIAGNOSTIC TEST | 64 | ||
| INTERVENTIONS FOR PATIENTS WITH DOCUMENTED CORONARY ARTERY DISEASE | 66 | ||
| SUMMARY | 68 | ||
| REFERENCES | 68 | ||
| Preoperative Evaluation | 71 | ||
| Key points | 71 | ||
| INTRODUCTION | 71 | ||
| PULMONARY PATHOPHYSIOLOGY IN THE PERIOPERATIVE PERIOD | 72 | ||
| DEFINITION OF POSTOPERATIVE PULMONARY COMPLICATIONS | 72 | ||
| PREOPERATIVE RISK ASSESSMENT | 74 | ||
| PULMONARY RISK FACTORS | 74 | ||
| Smoking | 74 | ||
| Chronic Obstructive Pulmonary Disease | 74 | ||
| Asthma | 75 | ||
| Interstitial Lung Disease | 75 | ||
| Upper Respiratory Tract Infection | 76 | ||
| NONPULMONARY FACTORS | 76 | ||
| Age | 76 | ||
| General Health Status | 76 | ||
| Obesity | 77 | ||
| Obstructive Sleep Apnea | 77 | ||
| Pulmonary Hypertension | 77 | ||
| Heart Failure | 77 | ||
| Chronic Kidney Disease | 78 | ||
| Nutritional Status | 78 | ||
| Dependent Functional Status | 78 | ||
| Neurologic Impairment | 78 | ||
| PROCEDURE-RELATED RISK FACTORS FOR POSTOPERATIVE PULMONARY COMPLICATIONS | 78 | ||
| Surgical Site | 78 | ||
| Duration of Surgery | 78 | ||
| Type of Anesthesia and Analgesia | 79 | ||
| Neuromuscular Blockade | 79 | ||
| Open Versus Laparoscopic Surgery | 79 | ||
| Emergency Surgery | 80 | ||
| PHYSICAL EXAMINATION | 80 | ||
| PREOPERATIVE PULMONARY TESTS | 80 | ||
| Pulmonary Function Test | 80 | ||
| Chest Radiograph | 81 | ||
| Arterial Blood Gas | 81 | ||
| Exercise Testing | 82 | ||
| Echocardiography | 82 | ||
| RISK SCORES | 82 | ||
| PERIOPERATIVE STRATEGIES TO DECREASE POSTOPERATIVE PULMONARY COMPLICATIONS | 84 | ||
| SUMMARY | 85 | ||
| REFERENCES | 85 | ||
| Stratification and Risk Reduction of Perioperative Acute Kidney Injury | 89 | ||
| Key points | 89 | ||
| DEFINITION | 89 | ||
| EPIDEMIOLOGY | 90 | ||
| RISK STRATIFICATION BASED ON SURGICAL SETTING | 90 | ||
| PROGNOSIS | 94 | ||
| EARLY DIAGNOSIS/NOVEL BIOMARKERS | 94 | ||
| RENAL PROTECTION STRATEGIES | 94 | ||
| SUMMARY AND RECOMMENDATIONS | 96 | ||
| REFERENCES | 97 | ||
| Perioperative Approach to Anticoagulants and Hematologic Disorders | 101 | ||
| Key points | 101 | ||
| COAGULATION DISORDERS | 101 | ||
| Assessment of Perioperative Bleeding Risk | 102 | ||
| Assessment of the Coagulation Pathway | 102 | ||
| Approach to prothrombin time abnormality | 102 | ||
| Approach to activated partial thromboplastin time abnormality | 104 | ||
| Approach to both prothrombin time and activated partial thromboplastin time abnormalities | 105 | ||
| Bleeding time | 105 | ||
| Hemophilia and Von Willebrand Disease | 105 | ||
| Hemophilia | 105 | ||
| Hemophilia C (factor XI deficiency or Rosenthal syndrome) | 107 | ||
| Von Willebrand disease | 107 | ||
| Assessment of Platelet Count and Dysfunction | 108 | ||
| Thrombocytopenia | 110 | ||
| Primary immune thrombocytopenia | 111 | ||
| Drug-induced thrombocytopenia | 111 | ||
| Heparin-induced thrombocytopenia | 112 | ||
| Disseminated intravascular coagulation | 112 | ||
| Platelet Dysfunction | 113 | ||
| Platelet Function Testing | 113 | ||
| Inherited Platelet Function Disorders | 114 | ||
| Glanzmann thrombasthenia | 114 | ||
| Bernard-Soulier syndrome | 114 | ||
| Chronic Kidney Disease | 114 | ||
| Special Hematologic Considerations | 114 | ||
| Sickle cell anemia | 114 | ||
| Glucose-6-phosphate dehydrogenase deficiency | 115 | ||
| Thrombocytosis | 116 | ||
| VENOUS THROMBOEMBOLISM RISK STRATIFICATION AND PREVENTION | 116 | ||
| Methods for Venous Thromboembolism Prevention | 117 | ||
| Key Points | 117 | ||
| Venous Thromboembolism Prevention in Patients Undergoing Hip or Knee Replacement Surgery | 118 | ||
| PERIOPERATIVE MANAGEMENT OF THE PATIENT ON CHRONIC ANTICOAGULANT THERAPY | 118 | ||
| Key Points | 119 | ||
| Target-specific Oral Anticoagulants | 120 | ||
| Other Key Points | 122 | ||
| REFERENCES | 123 | ||
| Innovation Treatment/Preparation Programs | H5 | ||
| Preoperative Anemia | 127 | ||
| Key points | 127 | ||
| INTRODUCTION | 127 | ||
| Definition | 127 | ||
| Epidemiology | 128 | ||
| Prevalence in general population | 128 | ||
| Prevalence in surgical population | 128 | ||
| PREOPERATIVE OPTIMIZATION OF PATIENTS AND ANEMIA EVALUATION | 128 | ||
| Should Evaluation for Anemia Be Part of the Preoperative Risk Assessment and Optimization? | 128 | ||
| Which Surgeries Require Measurement of Hemoglobin Preoperatively and When Should the Test be Scheduled? | 129 | ||
| What Should Be the Target Hemoglobin Preoperatively? | 129 | ||
| When Should the Surgery Be Postponed for Anemia Work-up and Treatment? | 130 | ||
| PREOPERATIVE ANEMIA, PERIOPERATIVE BLOOD TRANSFUSIONS, AND POSTOPERATIVE OUTCOMES | 130 | ||
| Mortality | 130 | ||
| Postoperative Complications | 131 | ||
| EVALUATION FOR ANEMIA | 131 | ||
| History | 132 | ||
| Signs, Symptoms, and Physical Examination | 133 | ||
| Laboratory Evaluation | 133 | ||
| TREATMENT OF ANEMIA | 136 | ||
| Nutritional Deficiency | 136 | ||
| Iron deficiency anemia | 136 | ||
| Vitamin B12 or folate deficiency | 136 | ||
| Stimulation of Erythropoiesis | 136 | ||
| Red Cell Transfusion | 137 | ||
| Allogeneic transfusion | 137 | ||
| Autologous transfusion | 137 | ||
| PREOPERATIVE ANEMIA MANAGEMENT IN PATIENTS WITH SICKLE CELL DISEASE | 137 | ||
| PATIENT BLOOD MANAGEMENT | 138 | ||
| SUMMARY | 138 | ||
| REFERENCES | 138 | ||
| Preoperative Nutrition and Prehabilitation | 143 | ||
| Key points | 143 | ||
| INTRODUCTION | 143 | ||
| PREOPERATIVE NUTRITION ASSESSMENT AND OPTIMIZATION | 144 | ||
| DETECTING MALNUTRITION BEFORE SURGERY | 144 | ||
| ROLE OF TOTAL PARENTERAL NUTRITION | 145 | ||
| AVOIDING INSULIN RESISTANCE AND POSTOPERATIVE HYPERGLYCEMIA | 146 | ||
| IMMUNONUTRITION | 147 | ||
| PREHABILITATION: PHYSICAL ACTIVITY AND HEALTH OUTCOMES | 147 | ||
| PREHABILITATION: EXERCISE TRAINING BEFORE A PHYSIOLOGIC CHALLENGE | 147 | ||
| EXERCISE PROGRAMS | 148 | ||
| 6-minute Walk Test | 149 | ||
| SUMMARY | 150 | ||
| REFERENCES | 150 | ||
| Special Considerations | H7 | ||
| Preoperative Evaluation of Patients with Diabetes Mellitus | 155 | ||
| Key points | 155 | ||
| INTRODUCTION | 155 | ||
| PATIENT EVALUATION OVERVIEW | 156 | ||
| Classification | 156 | ||
| Diabetes-Related Complications: Impact on Perioperative Risk | 157 | ||
| Autonomic Dysfunction | 157 | ||
| Gastroparesis | 158 | ||
| Cardiac autonomic neuropathy | 159 | ||
| COMORBIDITIES ASSOCIATED WITH DIABETES MELLITUS | 159 | ||
| MEDICATION CONSIDERATIONS | 160 | ||
| PHYSICAL EXAMINATION CONSIDERATIONS FOR THE ANESTHESIOLOGIST | 160 | ||
| Airway | 160 | ||
| Cardiovascular | 161 | ||
| Autonomic Dysfunction | 161 | ||
| Surgical Site Infection Screening | 161 | ||
| Preoperative Laboratory Testing | 161 | ||
| Preoperative Instructions | 161 | ||
| Anesthesia Plan | 161 | ||
| Intraoperative Glycemic Monitoring | 164 | ||
| Postoperative Glycemic Considerations | 164 | ||
| Continuous Subcutaneous Insulin Infusion (Insulin Pumps) | 165 | ||
| SUMMARY/DISCUSSION | 166 | ||
| REFERENCES | 166 | ||
| Preoperative Assessment of Geriatric Patients | 171 | ||
| Key points | 171 | ||
| INTRODUCTION | 171 | ||
| NEUROCOGNITIVE AND BEHAVIORAL ASSESSMENT | 172 | ||
| CARDIAC EVALUATION | 172 | ||
| PULMONARY EVALUATION | 173 | ||
| FUNCTIONAL ASSESSMENT | 173 | ||
| DELIRIUM | 174 | ||
| MEDICATION MANAGEMENT | 176 | ||
| NUTRITION | 177 | ||
| FRAILTY | 178 | ||
| COMPREHENSIVE GERIATRIC ASSESSMENT | 178 | ||
| THE DECISION FOR SURGERY | 179 | ||
| REFERENCES | 180 | ||
| Implantable Devices | 185 | ||
| Key points | 185 | ||
| INTRODUCTION | 185 | ||
| CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES | 186 | ||
| Possible Sources of Electromagnetic Interference and Its Consequences | 187 | ||
| Magnets | 188 | ||
| Cardiovascular Implantable Electronic Device Failure | 188 | ||
| MRI | 188 | ||
| Other Factors That Affect Cardiovascular Implantable Electronic Device Function | 188 | ||
| Preoperative Assessment | 189 | ||
| Intraoperative Management | 189 | ||
| VENTRICULAR ASSIST DEVICES | 190 | ||
| Specific Hemodynamic Considerations | 191 | ||
| NEUROSTIMULATORS | 191 | ||
| Deep Brain Stimulators | 193 | ||
| Spinal Cord Stimulators | 193 | ||
| Vagal Nerve Stimulators | 195 | ||
| Phrenic Nerve and Diaphragmatic Stimulators | 195 | ||
| Hypoglossal Nerve Stimulators | 195 | ||
| OTHER IMPLANTABLE DEVICES | 196 | ||
| SUMMARY | 196 | ||
| REFERENCES | 197 | ||
| Preoperative Evaluation of the Patient with Substance Use Disorder and Perioperative Considerations | 201 | ||
| Key points | 201 | ||
| SUBSTANCE USE DISORDER PATIENT | 201 | ||
| Incidence | 201 | ||
| Impact and Associated Illnesses | 202 | ||
| Perioperative Considerations | 202 | ||
| Screening for Substance Abuse | 202 | ||
| SPECIFIC ABUSED SUBSTANCES | 203 | ||
| Alcohol | 203 | ||
| Incidence | 203 | ||
| Effects of acute and chronic use | 203 | ||
| Perioperative considerations | 204 | ||
| Cannabinoids | 205 | ||
| Incidence | 205 | ||
| Effects of acute and chronic use | 205 | ||
| Perioperative considerations | 206 | ||
| Opioids and Heroin | 206 | ||
| Incidence | 206 | ||
| Effects of acute and chronic use | 206 | ||
| Perioperative considerations | 207 | ||
| Cocaine and Other Stimulants | 208 | ||
| The Pregnant Patient | 213 | ||
| Key points | 213 | ||
| PHYSIOLOGIC CHANGES OF PREGNANCY | 213 | ||
| MATERNAL EFFECTS OF ANESTHESIA AND SURGERY OR PROCEDURES | 214 | ||
| FETAL EFFECTS OF ANESTHESIA AND SURGERY OR PROCEDURES AND PREGNANCY OUTCOMES | 215 | ||
| Category A | 216 | ||
| Category B | 216 | ||
| Category C | 216 | ||
| Category D | 216 | ||
| Category X | 216 | ||
| Risks of Commonly Prescribed Drugs in the Perioperative Period | 217 | ||
| Sedatives or hypnotics | 217 | ||
| Inhaled anesthetics | 217 | ||
| Muscle relaxants | 217 | ||
| Opioids | 217 | ||
| Nonsteroidal anti-inflammatory drugs | 217 | ||
| Local anesthetics | 218 | ||
| Vasopressors | 218 | ||
| Ionizing radiation | 218 | ||
| NONOBSTETRIC SURGERIES OR PROCEDURES REQUIRING ANESTHESIA THAT OCCUR DURING PREGNANCY | 218 | ||
| PREOPERATIVE RECOMMENDATIONS | 218 | ||
| Coordination of Care and Assurance of Fetal Wellbeing | 218 | ||
| NPO Guidelines and Aspiration Pneumonia | 219 | ||
| INTRAOPERATIVE RECOMMENDATIONS | 220 | ||
| POSTOPERATIVE RECOMMENDATIONS | 220 | ||
| PREOPERATIVE PREGNANCY TESTING | 220 | ||
| SUMMARY | 220 | ||
| REFERENCES | 221 | ||
| Non-operating Room Anesthesia | 223 | ||
| Key points | 223 | ||
| INTRODUCTION | 223 | ||
| CHALLENGES OF NON-OPERATING ROOM PROCEDURES | 224 | ||
| QUALITY ASSURANCE | 225 | ||
| ADDING VALUE AS ANESTHESIOLOGISTS | 225 | ||
| ANESTHESIA VERSUS PROCEDURAL SEDATION | 226 | ||
| ASSESSMENT OF OUT-OF-THE-OPERATING ROOM ENVIRONMENT | 229 | ||
| PREOPERATIVE PATIENT ASSESSMENT | 231 | ||
| Cardiovascular System | 231 | ||
| CARDIOVASCULAR ASSESSMENT | 232 | ||
| PULMONARY ASSESSMENT | 233 | ||
| GASTROINTESTINAL ASSESSMENT | 234 | ||
| RENAL ASSESSMENT | 234 | ||
| OBSTETRIC ASSESSMENT | 234 | ||
| PROCEDURAL ASSESSMENT | 235 | ||
| DIAGNOSTIC TESTING | 235 | ||
| PREPROCEDURAL MEDICATION MANAGEMENT | 237 | ||
| FUTURE DIRECTIONS | 237 | ||
| REFERENCES | 238 | ||
| Index\r | 241 |