Anesthesia Student Survival Guide.pdf - Index of

THe PreoPerATIve PATIenT evAluATIon ● 89
Step 5: Patients with poor/unknown functional capacity
In these patients, the presence or absence of active clinical risk factors
determines the need for further evaluation.
Clinical Risk Factors for Increased Perioperative Cardiac Risk
History of heart disease (MI, Q waves on eCG, known CAD)
History of compensated or prior heart failure
History of cerebrovascular disease
Diabetes mellitus
renal insufficiency
# Clinical risk
factors
Pulmonary
Postoperative pulmonary complications can prolong the hospital stay by
an average of 1–2 weeks. Therefore, it is important to review patient and
procedure-related risk factors, perform a clinical evaluation, and recommend
risk-reduction strategies to improve patient care and outcome.
Potential patient-related risk factors for perioperative pulmonary complications
include:
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Smoking
Poor general health status (ASA > 2)
Old age (>70)
Obesity
Chronic obstructive pulmonary disease
Reactive Airway Disease (Asthma)
Potential procedure-related risk factors include:
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Surgery > 3 h
General anesthesia
Surgical Risk Action
0 Any Proceed with surgery
1–2 Intermediate risk surgery Proceed with surgery with heart rate control
vascular surgery or
3 + Intermediate risk surgery Consider cardiac testing if it will change management
vascular surgery Consider cardiac testing if it will change management
Source: ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for
Noncardiac Surgery: Executive Summary. JACC Vol. 50, No. 17, 2007.