Preoperative assessment from a clinical point of view

  • M. Greher
  • H. Tschernich
  • M. Zimpfer
Conference paper


Perioperative management and care of a patient requiring surgery represents the single most complex and cooperative task in medicine. Considering the evolutionary concept of performing perioperative medicine instead of simply administering anaesthesia, every anaesthesiologist today is confronted with the unique challenge and chance of qualifying in this field. Optimal and efficient preoperative assessment of the patient is the crucial step at the beginning of this whole process, and is often decisive in determining what follows.


Preoperative Assessment Percutaneous Coronary Interven Dobutamine Stress Echocardiography Noncardiac Surgery Major Vascular Surgery 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Beecher HK, Todd DP (1954) A study of death associated with anesthesia and surgery. Ann Surg 140: 2–34PubMedCrossRefGoogle Scholar
  2. 2.
    Lunn JN, Hunter AR, Scott DB (1983) Anaesthesia-related surgical mortality. Anaesthesia 38: 1090–1096PubMedCrossRefGoogle Scholar
  3. 3.
    Anesthesiologists ASA (1963) New classification of physical status. Anesthesiology 24: 111.Google Scholar
  4. 4.
    Goldman L, Caldera DL, Nussbaum SR et al (1977) Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297: 845–850PubMedCrossRefGoogle Scholar
  5. 5.
    Detsky AS, Abrams HB, Forbath N et al (1986) Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med 146: 2131–2134PubMedCrossRefGoogle Scholar
  6. 6.
    Heinisch RH, Barbieri CF, Nunes Filho JR et al (2002) Prospective assessment of different indices of cardiac risk for patients undergoing noncardiac surgeries. Arq Bras Cardiol 79: 327–338PubMedCrossRefGoogle Scholar
  7. 7.
    Prause G, Ratzenhofer-Comenda B, Pierer G et al (1997) Can ASA grade or Goldman’s cardiac risk index predict peri-operative mortality? A study of 16,227 patients. Anaesthesia 52: 203–206PubMedCrossRefGoogle Scholar
  8. 8.
    Dupuis JY, Nathan HJ, Wynands JE (1991) Clinical application of cardiac risk indices: how to avoid misleading numbers. Can J Anaesth 38: 1055–1064PubMedCrossRefGoogle Scholar
  9. 9.
    Ashton CM, Petersen NJ, Wray NP et al (1993) The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Intern Med 118: 504–510PubMedGoogle Scholar
  10. 10.
    Greher M, Wolrab C, Wildling E et al (1998) Perioperative myocardial ischemia and assessment of regional left ventricular function with transesophageal echocardiography ( TEE ). Acta Anaesthesiol Scand 42: 181–184CrossRefGoogle Scholar
  11. 11.
    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: 1043–1049PubMedGoogle Scholar
  12. 12.
    Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72: 153–184PubMedCrossRefGoogle Scholar
  13. 13.
    Boersma E, Poldermans D, Bax JJ et al (2001) Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 285: 1865–1873CrossRefGoogle Scholar
  14. 14.
    Mantilla CB, Horlocker TT, Schroeder DR et al (2002) Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology 96: 1140–1146PubMedCrossRefGoogle Scholar
  15. 15.
    Fleisher LA, Eagle KA (2001) Clinical practice. Lowering cardiac risk in noncardiac surgery. N Engl J Med 345: 1677–1682PubMedCrossRefGoogle Scholar
  16. 16.
    Lee A, Chui PT, Gin T (2003) Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions. Anesth Analg 96:1424–1431, table of contentsPubMedCrossRefGoogle Scholar
  17. 17.
    Mangano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335: 1713–1720PubMedCrossRefGoogle Scholar
  18. 18.
    Poldermans D, Boersma E, Bax JJ et al (2001) Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur Heart J 22: 1353–1358PubMedCrossRefGoogle Scholar
  19. 19.
    Wijeysundera DN, Naik JS, Beattie WS (2003) Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complication: a meta-analysis. Am J Med 114: 742–752PubMedCrossRefGoogle Scholar
  20. 20.
    Poldermans D, Bax JJ, Kertai MD et al (2003) Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation 107: 1848–1851PubMedCrossRefGoogle Scholar
  21. 21.
    Grayburn PA, Hillis LD (2003) Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy. Ann Intern Med 138: 506–511PubMedGoogle Scholar
  22. 22.
    Goldman L (2003) Evidence-based perioperative risk reduction. Am J Med 114: 763–764PubMedCrossRefGoogle Scholar
  23. 23.
    VanDenKerkhof EG, Milne B, Parlow JL (2003) Knowledge and practice regarding prophylactic perioperative beta blockade in patients undergoing noncardiac surgery: a survey of Canadian anesthesiologists (table of contents). Anesth Analg 96: 1558–1565PubMedCrossRefGoogle Scholar
  24. 24.
    Warltier DC (1998) Beta-adrenergic-blocking drugs: incredibly useful, incredibly underutilized. Anesthesiology 88: 2–5PubMedCrossRefGoogle Scholar
  25. 25.
    ASA Task Force on Preanesthesia Evaluation (2002) Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 96: 485–496Google Scholar
  26. 26.
    Prause G, Ratzenhofer-Komenda B, Smolle-Juettner F et al (1998) Operations on patients deemed “unfit for operation and anaesthesia”: what are the consequences? Acta Anaesthesiol Scand 42: 316–322PubMedCrossRefGoogle Scholar
  27. 27.
    McKee RF, Scott EM (1987) The value of routine preoperative investigations. Ann R Coll Surg Engl 69: 160–162PubMedGoogle Scholar
  28. 28.
    Narr BJ, Warner ME, Schroeder DR et al (1997) Outcomes of patients with no laboratory assessment before anesthesia and a surgical procedure. Mayo Clin Proc 72: 505–509PubMedCrossRefGoogle Scholar
  29. 29.
    Schein OD, Katz J, Bass EB et al (2000) The value of routine preoperative medical testing before cataract surgery. Study of medical testing for cataract surgery. N Engl J Med 342: 168–175PubMedCrossRefGoogle Scholar
  30. 30.
    Eagle KA, Berger PB, Calkins H et al (2002) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery — executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 105: 1257–1267PubMedGoogle Scholar
  31. 31.
    West JC, Napoliello DA, Costello JM et al (2000) Preoperative dobutamine stress echocardiography versus cardiac arteriography for risk assessment prior to renal transplantation. Transplant Int 13: S27–30Google Scholar
  32. 32.
    Takhtehchian DS, Novaro GM, Barnett G et al (2002) Safety of dobutamine stress echocardiography in patients with unruptured intracranial aneurysms. J Am Soc Echocardiogr 15: 1401–1404PubMedCrossRefGoogle Scholar
  33. 33.
    Sicari R, Ripoli A, Picano E et al (2002) Long-term prognostic value of dipyridamole echocardiography in vascular surgery: a large-scale multicenter study. Coron Artery Dis 13: 49–55PubMedCrossRefGoogle Scholar
  34. 34.
    Poldermans D, Bax JJ, Thomson IR et al (2000) Role of dobutamine stress echocardiography for preoperative cardiac risk assessment before major vascular surgery: a diagnostic tool comes of age. Echocardiography 17: 79–91PubMedCrossRefGoogle Scholar
  35. 35.
    Dhond MR, Nguyen TT, Sabapathy R et al (2003) Dobutamine stress echocardiography in preoperative and long-term postoperative risk assessment of elderly patients. Am J Geriatr Cardiol 12: 107–109, 112Google Scholar
  36. 36.
    Das MK, Pellikka PA, Mahoney DW et al (2000) Assessment of cardiac risk before nonvascular surgery: dobutamine stress echocardiography in 530 patients. J Am Coll Cardiol 35: 1647–1653PubMedCrossRefGoogle Scholar
  37. 37.
    Bossone E, Martinez FJ, Whyte RI et al (1999) Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery. J Thorac Cardiovasc Surg 118: 542–546PubMedCrossRefGoogle Scholar
  38. 38.
    ) Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. American College of Physicians. Ann Intern Med 127: 309–312Google Scholar
  39. 39.
    Gordon AJ, Macpherson DS (2003) Guideline chaos: conflicting recommendations for preoperative cardiac assessment. Am J Cardiol 91: 1299–1303PubMedCrossRefGoogle Scholar
  40. 40.
    Metzler H (2003) Lowering cardiac risk by preoperative interventions. Minerva Anestesiol 69: 412–415PubMedGoogle Scholar
  41. 41.
    Posner KL, Van Norman GA, Chan V (1999) Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty. Anesth Analg 89: 553–560PubMedGoogle Scholar
  42. 42.
    Kaluza GL, Joseph J, Lee JR et al (2000) Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 35: 1288–1294PubMedCrossRefGoogle Scholar
  43. 43.
    Bonow RO, Carabello B, de Leon AC et al (1998) ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines ( Committee on Management of Patients With Valvular Heart Disease ). J Heart Valve Dis 7: 672–707PubMedGoogle Scholar
  44. 44.
    Pate P, Tenholder MF, Griffin JP et al (1996) Preoperative assessment of the high-risk patient for lung resection. Ann Thorac Surg 61: 1494–1500PubMedCrossRefGoogle Scholar
  45. 45.
    Arozullah AM, Khuri SF, Henderson WG et al (2001) Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 135: 847–857PubMedGoogle Scholar
  46. 46.
    Hulzebos EH, Van Meeteren NL, De Bie RA et al (2003) Prediction of postoperative pulmonary complications on the basis of preoperative risk factors in patients who had undergone coronary artery bypass graft surgery. Phys Ther 83: 8–16PubMedGoogle Scholar
  47. 47.
    Badner NH, Craen RA, Paul TL et al (1998) Anaesthesia preadmission assessment: a new approach through use of a screening questionnaire. Can J Anaesth 45: 87–92PubMedCrossRefGoogle Scholar
  48. 48.
    Essin DJ, Dishakjian R, deCiutiis VL et al (1998) Development and assessment of a computer-based preanesthetic patient evaluation system for obstetrical anesthesia. J Clin Monit Comput 14: 95–100PubMedCrossRefGoogle Scholar
  49. 49.
    van Klei WA, Moons KG, Rutten CL et al (2002) The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay (table of contents). Anesth Analg 94: 644–649PubMedCrossRefGoogle Scholar
  50. 50.
    Fischer SP (1996) Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology 85: 196–206PubMedCrossRefGoogle Scholar
  51. 51.
    Pollard JB, Zboray AL, Mazze RI (1996) Economic benefits attributed to opening a preoperative evaluation clinic for outpatients. Anesth Analg 83: 407–410PubMedGoogle Scholar
  52. 52.
    Pollard JB, Olson L (1999) Early outpatient preoperative anesthesia assessment: does it help to reduce operating room cancellations? Anesth Analg 89: 502–505PubMedGoogle Scholar
  53. 53.
    Pollard JB, Garnerin P (1999) Outpatient preoperative evaluation clinic can lead to a rapid shift from inpatient to outpatient surgery: a retrospective review of perioperative setting and outcome. J Clin Anesth 11: 39–45PubMedCrossRefGoogle Scholar
  54. 54.
    Greer AE, Irwin MG (2002) Implementation and evaluation of guidelines for preoperative testing in a tertiary hospital. Anaesth Intensive Care 30: 326–330PubMedGoogle Scholar
  55. 55.
    Tsen LC, Segal S, Pothier M et al (2000) Survey of residency training in preoperative evaluation. Anesthesiology 93: 1134–1137PubMedCrossRefGoogle Scholar
  56. 56.
    Donahue BS, Gailani D, Higgins MS et al (2003) Factor V Leiden protects against blood loss and transfusion after cardiac surgery. Circulation 107: 1003–1008PubMedCrossRefGoogle Scholar
  57. 57.
    Ziegeler S, Tsusaki BE, Collard CD (2003) Influence of genotype on perioperative influence and outcome. Anesthesiology 99: 212–219PubMedCrossRefGoogle Scholar
  58. 58.
    Silber JH, Kennedy SK, Even-Shoshan O et al (2002) Anesthesiologist board certification and patient outcomes. Anesthesiology 96: 1044–1052PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2004

Authors and Affiliations

  • M. Greher
  • H. Tschernich
  • M. Zimpfer

There are no affiliations available

Personalised recommendations