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Author 42 Posts
James
Senior Member

Topics: 14
Posts: 127
Posted 12/29/11 - 03:03 AM report   #41
The most sensitive tool for assessing impairment of short-term memory is the three-word recall test. The clock-drawing test is useful to evaluate cognitive deterioration over time.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/29/11 - 05:37 AM report   #42
Key Points
Preoperative testing should be selective and based on the likelihood of finding an abnormality that will change management.

Medications that should be discontinued or modified before surgery include antiplatelet agents, anticoagulants, hypoglycemic drugs, and corticosteroids.

Most cardiac medications should be continued perioperatively, with the exception of diuretics in patients who may be hypovolemic and antiplatelet agents.

In patients with active cardiac conditions, noncardiac elective surgery should be delayed or canceled pending further evaluation and treatment.

Patients with adequate functional capacity and without active cardiac conditions can usually proceed to surgery without preoperative cardiovascular testing.

Beta Blockers and statins should be continued perioperatively in patients already taking these agents, and their use should be considered in high-risk patients scheduled for high-risk surgery.

Smoking cessation more than 8 weeks before surgery improves pulmonary function and may decrease the incidence of complications.

Good evidence supports the use of routine lung expansion maneuvers to prevent postoperative pulmonary complications.

Preoperative spirometry and chest radiography should not be used routinely for predicting risk for postoperative pulmonary complications.

Sequential compression devices should only be used as sole prophylaxis for venous thromboembolism in patients at high risk for bleeding or with contraindications to pharmacologic prophylaxis.

The risk for venous thromboembolism (VTE) is highest in patients with multiple risk factors for VTE and in those undergoing hip or knee arthroplasty, hip fracture surgery, and surgery for major trauma or spinal cord injury.

Effective preventive strategies for patients at highest risk for venous thromboembolism include low-molecular-weight heparin, vitamin K antagonist, and fondaparinux.

Screening tests for coagulopathy are indicated only in patients with a personal or family history of a bleeding disorder or in patients with alcohol or drug abuse, liver disease, or on anticoagulants.

Although there is no clear cut-off for perioperative blood transfusion in patients with anemia, a threshold hemoglobin level of 7 to 8 g/dL (70-80 g/L) in otherwise stable asymptomatic patients is generally recommended.

Most experts do not recommend intensive insulin control for critically ill patients, including surgical patients in the intensive care unit.

Mild to moderate hypothyroidism does not increase surgical risk, but hyperthyroidism does and should be treated preoperatively.

Patients with a history of corticosteroid use should be considered for stress-dose coverage if they took more than the equivalent of 20 mg/d prednisone for at least 3 weeks within the past 6 to 12 months.

Predictors of postoperative renal failure include older age, emergency or high-risk surgery, liver disease, peripheral arterial disease, BMI of 32 or greater, chronic obstructive pulmonary disease requiring bronchodilator therapy, intraoperative vasopressors, and diuretic use.

Chronic hepatitis that is medically stable does not usually significantly increase surgical risk.

Asymptomatic bruits are not correlated with risk of postoperative stroke and rarely warrant further investigation preoperatively.

Elective surgery should be postponed for at least 2 weeks after a stroke.

Management of postoperative delirium includes a quiet environment, treating the precipitating causes, avoiding physical restraints, and use of low-dose haloperidol.


Edited by James on 12/30/11 - 12:51 AM
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