Anesthesia Student Survival Guide.pdf - Index of

THe PreoPerATIve PATIenT evAluATIon ● 87
ventilation is judged to be high, careful anesthetic planning (e.g., ensuring that
a difficult airway cart is available) is needed.
The second most common airway complication involves patient dentition.
It is imperative to discuss with the patient if he/she has any dentures, loose
teeth, caps, crowns or anything else that can put the patient at risk for tooth
injury or aspiration of a dislodged piece.
Cardiovascular
In evaluating the cardiovascular system, the main objective should be to decide
whether a patient needs further cardiac testing (stress test) or intervention
(cardiac catheterization) prior to elective surgery.
Patients should be asked about any history of heart attacks, hypertension,
shortness of breath, dyspnea, use of anticoagulants, diuretics, heart surgery,
edema, chest pain, chest tightness, use of antibiotics before dental work, blood
pressure medication, last echocardiogram, or stress test.
One should then determine a patient’s functional capacity (see table below).
Studies have correlated better perioperative outcome with patients whose
metabolic equivalent (MET) activity was greater than or equal to 4 METs
(see Table 8.1).
The revised ACC/AHA guidelines (2007) recommend the following
stepwise approach to evaluating a patient’s cardiac status for patients undergoing
noncardiac surgery:
Table 8.1 Energy requirements for various activities.
1 MeT eating, getting dressed, working at a desk
2 MeTS Showering, walking down eight steps
3 MeTS Walking on a flat surface for one or two blocks
4 MeTS raking leaves, weeding or pushing a power mower
5 MeTS Walking four miles per hour, social dancing, washing car
6 MeTS nine holes of golf carrying clubs, heavy carpentry, using push mower
7 MeTS Digging, spading soil, singles tennis, carrying 60 pounds
8 MeTS Moving heavy furniture, jogging slowly, rapidly climbing stairs, carrying 20 pounds upstairs
9 MeTS Bicycling at a moderate pace, sawing wood, slow jumping rope
10 MeTS Brisk swimming, bicycling uphill, walking briskly uphill, jogging at 6 MPH
11 MeTS Cross-country skiing, full court basketball
12 MeTS running continuously at 8 MPH
Adapted with permission from Brigham and Women’s Hospital Preoperative Assessment Form.