The Medical clinics of North America
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Clinicians are increasingly asked what they can do to evaluate and lower the risk of perioperative cardiac complications. Approximately 4 decades ago, there were few tools to guide the evaluation of perioperative risk. ⋯ None of these tests, however, were designed to identify perioperative cardiac risk. This article reviews the literature on perioperative risk assessment, risk reduction, and testing modalities in patients with cardiac disease, along with the role of perioperative angioplasty and the current American College of Cardiology/American Heart Association guidelines.
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Anemia is commonly encountered in the preoperative patient. Determination of the cause of the anemia can affect perioperative surgical and medical management and outcome. ⋯ The authors review the evaluation of anemia and evidence regarding perioperative blood transfusions. Recommendations on the treatment of anemia, including perioperative blood transfusions, are outlined.
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Preoperative pulmonary evaluation and optimization improves postoperative patient outcomes. Clinicians frequently evaluate patients with pulmonary disease before surgery who are at increased risk for pulmonary and nonpulmonary perioperative complications. ⋯ Risk stratification for postoperative pulmonary complications and strategies to reduce them for high-risk patients are also discussed. From the available literature, high-risk patients and those patients for whom a multidisciplinary collaboration will be most helpful can be accurately identified.
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Contemporary life, with its sedentary lifestyles, fast foods, processed foodstuff, and desk-bound service employment, is beset by an epidemic of overweight and obese individuals. The World Health Organization reported that worldwide a billion adults are overweight and at least 30% of them are obese. ⋯ Obesity and the metabolic syndrome are unfortunately becoming increasingly common perioperative issues. The ultimate aim of caring for such patients is to find ways to minimize the untoward effects of surgery in patients who are obese or have metabolic syndrome.