Preoperative Assessment of Perioperative Risk on a Chronic Heavy Smoker with a Large Aneurysm

Abstract

A 48-year old male presented with an abdominal aortic aneurysm. He had smoked 10–15 cigarettes daily for about 20 years. He had a history of chest pain after a myocardial infarction (MI), for which he underwent coronary bypass surgery 10 years ago. After bypass surgery, he had no symptoms until recently; these later symptoms were less severe than previously. The patient also complained of shortness of breath during light exercise. Three months ago, he experienced a period of disturbed speech, which resolved spontaneously within 12 h. Physical examination showed an obese man of height 172 cm and weight 98 kg. Blood pressure was 130/80 mm Hg and pulse was 80 bpm. Examination of the chest revealed rhonchi and a third heart sound. Palpation of the abdomen showed an aortic aneurysm with an estimated diameter of 6 cm. The patient was referred to the vascular surgeon. Blood tests showed normal renal function. Fasting cholesterol was 8.3 mmol/1 and glucose was 12.6 mmol/L. Electrocardiography (ECG) showed a sinus rhythm and pathological Q-waves in leads II, III and AVF, suggestive of an old inferior infarction. Spirometry showed an obstructive pattern. The total lung capacity was normal. However, the vital capacity and forced expiratory volume in 1 s (FEV1) were decreased: FEV1 was 68 per cent of the predicted normal value corrected for gender and age.