Preoperative care

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Preoperative care is defined as "Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins."[1]

Components of preoperative care

Cardiac risk reduction

Guidelines[2] by the American College of Cardiology (ACC) and American Heart Association (AHA) recommend (as summarized by Journal Watch:[3]

  • "Patients scheduled for low-risk noncardiac surgery should proceed to surgery."
  • "Patients with good functional capacity should proceed to surgery."
  • "Patients with poor or unknown functional capacity who are scheduled for non-low-risk surgery should be stratified according to the Revised Cardiac Risk Index[4] (Journal Watch Sep 17 1999). Patients with no risk factors should proceed to surgery. For those with one or more risk factors, clinicians are given the option of proceeding with surgery or performing noninvasive stress testing; the decision should be influenced by the type of noncardiac surgery (vascular vs. other), and by whether the clinician believes that noninvasive testing "will change management."
  • "For patients with risk factors, clinicians should consider perioperative ß-blockade."
  • "The algorithm does not apply to patients who require emergency noncardiac surgery, or to patients with active cardiac problems that mandate urgent intervention (e.g., unstable coronary syndromes, decompensated heart failure, important arrhythmias, severe valvular disease)."

Pulmonary risk reduction

Smoking cessation may reduce pulmonary complications according to the results of a randomized controlled trial.[5]

Incentive spirometry does not clearly help reduce pulmonary complications during the perioperative care after coronary artery bypass grafting according to a meta-analysis of randomized controlled trials by the Cochrane Collaboration. [6]

Benefits of preoperative medical consultation

The benefits of consultation are not clear in an observational study.[7]

References

  1. ↑ National Library of Medicine. Preoperative care. Retrieved on 2007-11-21.
  2. ↑ Fleisher LA, Beckman JA, Brown KA, et al (2007). "ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery". Circulation 116 (17): 1971–1996. DOI:10.1161/CIRCULATIONAHA.107.185700. PMID 17901356. Research Blogging.
  3. ↑ Brett AS (2007-11-20). Guidelines for Perioperative Cardiovascular Evaluation for Patients Considering Noncardiac Surgery. Retrieved on 2007-11-21.
  4. ↑ Lee TH, Marcantonio ER, Mangione CM, et al (1999). "Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery". Circulation 100 (10): 1043–9. PMID 10477528. [e]
  5. ↑ Møller AM, Villebro N, Pedersen T, Tønnesen H (2002). "Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial". Lancet 359 (9301): 114–7. PMID 11809253. [e]
  6. ↑ Freitas ER, Soares BG, Cardoso JR, Atallah AN (2007). "Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft". Cochrane Database Syst Rev (3): CD004466. DOI:10.1002/14651858.CD004466.pub2. PMID 17636760. Research Blogging.
  7. ↑ Auerbach AD, Rasic MA, Sehgal N, Ide B, Stone B, Maselli J (2007). "Opportunity missed: medical consultation, resource use, and quality of care of patients undergoing major surgery". Arch. Intern. Med. 167 (21): 2338–44. DOI:10.1001/archinte.167.21.2338. PMID 18039993. Research Blogging.

See also

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