Anesthesia Student Survival Guide.pdf - Index of

THe PreoPerATIve PATIenT evAluATIon ● 91
Gastrointestinal diseases may increase the potential for aspiration,
dehydration, electrolyte disturbances, and anemia. While screening for gastrointestinal
disease, it is important to inquire about history of hiatal hernia,
diarrhea, bloody stools, heartburn, food regurgitation, gastric ulcers, nausea,
vomiting, viral hepatitis, and alcoholism.
Bleeding Disorders
A history of a bleeding disorder can increase a risk of perioperative complications,
and necessitate further preoperative evaluation and planning. Possible causes of
bleeding may be due to disorders of coagulation factors (e.g., hemophilia, Von
Willebrand’s disease), cancer, thrombocytopenia, leukemia, certain medications
(e.g., warfarin, heparin, clopidrogel), platelet disorders (e.g., Bernard–Soulier
syndrome), and liver disease.
endocrine
Endocrinopathies can carry a high risk for morbidity and mortality. Patients
should be assessed for any history of risk factors for diabetes mellitus.
Diabetic patients should be evaluated with regard to the type, duration, and
severity of disease. The patient’s current therapy (diet, oral hypoglycemic drug,
or insulin regimen) should be assessed, along with a morning blood sugar and
HbA1c to determine degree of control. All diabetics should be evaluated for the
presence of coronary artery disease and hypertension. Additionally, a serum
creatinine level may be drawn to assess a patient’s degree of nephropathy. Most
providers will avoid regional anesthesia techniques in diabetics with severe
peripheral neuropathy. Typically, patients on insulin are instructed to take half
their morning dose of insulin on the day of surgery. Diabetics should also
be scheduled for elective surgery early in the day, to minimize the impact of
prolonged fasting on their blood sugar management.
Perioperative mortality associated with pheochromocytoma and the
carcinoid syndrome can reach 50% if undiagnosed. Thus, screening patients for
any history of thyroid, parathyroid, carcinoid syndrome, adrenal and pituitary
diseases can help decrease potential perioperative risks.
renal
History of any kidney disorder holds importance during the preoperative
evaluation, since derangement in kidney function can contribute to secondary
physiologic imbalances, deficits in platelet function (impaired aggregation),