Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
in Healthy Patients
Mazen Badawi
Medical Resident
1/2010
Introduction
3 Severe disease process which limits activity but is not incapacitating 1.2%
Cardiac :
Inhalational agents are mycardial depressant
Accentuated hypotensive response
Anesthesia risk
Pulm. :
Vital capacity decreased by 50%
Decreased Fun.Resd.C below closing volumes
atelectasis and V/Q mismatch
Decreased mucociliary clearance
Depression of response to hypoxia and
hypercarbia
Diaphragmatic dysfunction
Anesthesia risk
complications
Assessment of healthy indiv.
17 Q
Resp, CVS : SOB, chest pain when climbing 2 flight
of stairs, hx of heart attack, angina, HF, asthma,
bronchitis
Renal disease
Neuro: stroke, epilepsy
Anesthesia : previous problems in family
Thyroid disease
Liver disease
Joint pain, stiffness esp. neck and jaw
DM and insulin use
Clinical assessment
1- Exercise capacity :
poor if symptomatic with walking 4
blocks or climbing 2 flights of stairs
doubles the risk for post op.
complications, CVS complications but
not pulm.
Clinical assessment
2- Medication use :
Including OTC, complementary,
alternative
Clinical assessment
PE
Clinical Assessment
Surgical Procedure on
Type & Screen List
No of Units
Age:
<45
45-70
>70
Cvs, HTN
Pulmonary disease
Malignancy
Hepatic disease/ETOH
Renal disease
Blood disorders
Diabetes
Use of Steroids
Use of Anticoagulants
CNS disease
Sickle Risk*
CBC
Anemia is present in 1% of
asymptomatic ppl
Conclusion:
CBC is recommended in:
All pt. >65 yr before major surgery
minor surgery
Electrolytes
Nephrotoxic Rx
B.S
25% of >60 yr have abnormal b.s level.
incidence of asymptomatic hyperglycemia is
unknown.
No relationship between op. risk and DM
except in vascular & CABG (but not asymp.
hyperglycemia)
routine measurement of b.s is not
recommended in healthy ppl before surgery
LFT
UTI
Recommended in:
>50 yr undergoing major surg.