Preoperative Risk Assessment and Intraoperative Monitoring
In emergency surgical settings, opportunities for optimization of the patient are usually limited due to the lack of time and often the hours during which surgery is required. However, in elective surgical settings, especially with higher-risk patients who have multiple comorbidities, preoperative evaluation and optimization are important considerations to reduce the risk of adverse events and to improve clinical outcomes. This chapter aims to provide information on perioperative assessment and intraoperative monitoring in an effort to reduce the rates of complications, risks, and consequences associated with surgery. For other associated procedures, refer to the relevant chapter or volume.
KeywordsObesity Ischemia Nicotine Angiotensin Fentanyl
Further Reading, References, and Resources
- American Society of Anesthesiologists. Standards of the American Society of Anesthesiologists: standards for basic anesthetic monitoring. Available at: http://www.asahq.org/Standards/02.html. Accessed 23 May 2009.
- Centers for Disease Control and Prevention. Measuring physical activity intensity: Metabolic Equivalent (MET) level. Atlanta: Centers for Disease Control and Prevention.Google Scholar
- Deaths during general anesthesia: technology-related, due to human error, or unavoidable? An ECRI technology assessment. J Health Care Technol. 1985;1:155–75.Google Scholar
- Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al., 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); 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; Society for Vascular Surgery. Circulation. 200723;116(17):e418–99. Erratum in: Circulation. 2008;118(9):e143–4. Circulation. 2008;117(5):e154.Google Scholar
- Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. 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). Anesth Analg. 2008;106(3):685–712.PubMedCrossRefGoogle Scholar
- Hoeks SE, Scholte OP, Reimer WJ, Lenzen MJ, van Urk H, Jörning PJ, Boersma E, et al. Guidelines for cardiac management in noncardiac surgery are poorly implemented in clinical practice: results from a peripheral vascular survey in the Netherlands. Anesthesiology. 2007;107(4):537–44.PubMedCrossRefGoogle Scholar
- Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, editor. Evaluation of chemotherapeutic agents. New York: Columbia University Press; 1949. p. 196.Google Scholar
- National Transportation Safety Board. Aviation accident statistics. Available at: http://www.ntsb.gov/aviation/Stats.htm. Accessed 28 May 2001.
- Rodseth RN, Lurati Buse GA, Bolliger D, Burkhart CS, Cuthbertson BH, Gibson SC, et al. The predictive ability of pre-operative B-type natriuretic peptide in vascular patients for major adverse cardiac events: an individual patient data meta-analysis. J Am Coll Cardiol. 2011;58(5):522–9.PubMedCrossRefGoogle Scholar
- Salim DI, Auerbach AD. Chapter 24. The impact of intraoperative monitoring on patient safety. http://www.ahrq.gov/clinic/ptsafety/chap24.htm.
- Schwarz G, Mausser G, Litscher G, Ohner U, Schoepfer A, Friedrich G. BIS readings of aspect A 2000 monitor are not contaminated by transmitted oscillations induced by jet ventilation. Internet J Neuromonit. 2005;4(1). http://www.cdc.gov/nccdphp/dnpa/physical/measuring/met.htm.
- Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47.Google Scholar
Obstructive Sleep Apnea
- Laskey W, Yancy C, Maisel W. Thrombosis in coronary drug-eluting stents: report from the meeting of the Circulatory System Medical Devices Advisory Panel of the Food and Drug Administration Centre for Devices and Radiologic Health, December 7–8, 2006. Circulation. 2007;115(17):2352–7.Google Scholar
- Poldermans D, Schouten O, Vidakovic R, Bax JJ, Thomson IR, Hoeks SE, et al. A clinical randomised trial to evaluate the safety of a non-invasive approach in high-risk patients undergoing major vascular surgery: the DECREASE-V pilot study. J Am Coll Cardiol. 2007;49:1763–9.PubMedCrossRefGoogle Scholar
- Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81.Google Scholar
- Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT, American College of Chest Physicians. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines. 2nd edition. Chest. 2007;132(3 Suppl):161S–77S.Google Scholar
- Fleisher L, Beckman J, Brown K, Calkins H, Chaikof E, Fleischmann K, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery. Circulation. 2007;116(17):e418–e500.Google Scholar
- Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. 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. J Am Colloid Cardiol. 2007;50(17):1707–32. Erratum in: J Am Colloid Cardiol. 2008;52(9):794–7.Google Scholar
Perioperative Antiplatelet Therapy
Assessment of Exercise Tolerance
Ageing and Surgery
- Jingming B, Jun H, Tadaki N, Takayuki S, Atsushi K. Influence of ageing on perioperative cardiac risk in non-cardiac surgery. Age Ageing. 2007;36(2):68–72.Google Scholar
Perioperative Venous Thromboprophylaxis
- Geerts W, Pineo G, Heit J, Bergqvist D, Lassen M, Colwell C, Ray J. Prevention of venous thromboembolism: the 7th ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:338S–400S.Google Scholar
- National Health and Medical Research Council. Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals. Melbourne: National Health and Medical Research Council; 2009. ISBN Online: 1864964480. www.nhmrc.gov.au.
Online Resources (Accessed June 2008)
- American College of Cardiology Guidelines for cardiac diseases. 2007. www.acc.org.
- Australian and New Zealand College of Anaesthetists Report. Safety of anaesthesia in Australia: a review of anaesthesia-related mortality 2000–2002. http://www.anzca.edu.au/resources/books-and-publications.
- Kidney Health Australia Resource and useful quick online eGFR calculator. www.kidney.org.au.
- Society for Preoperative Assessment and Quality Improvement. www.spaqi.org.
- The National Institute for Clinical Excellence Guidelines for best practice. www.nice.org.uk.