The Medical clinics of North America
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Med. Clin. North Am. · Nov 2024
ReviewPerioperative Care of Heart Failure, Arrhythmias, and Valvular Heart Disease.
Frequently, the question of whether or not a patient is stable for surgery boils down to the question, "Does this patient need a preoperative stress test?" However, coronary artery disease and ischemic heart disease are only some of the many cardiac conditions that patients present with preoperatively-and that can negatively impact their intraoperative management and postoperative outcomes. This article will explore the evidence based, patient centered best practices surrounding the perioperative evaluation and management of heart failure, arrhythmias, and valvular heart disease.
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Surgery under anesthesia poses a significant stress to the body, and postoperative complications occur in up to 20% of cases. An understanding of postoperative complications, including assessment of patients at risk, risk mitigation, early recognition, and evidence-based treatment, is essential to provide high-value health care. Common postoperative complications reviewed in this article include fever, cerebrovascular accident, nausea and vomiting, ileus, and urinary retention, including discussion of pathophysiology, prevention, and treatment.
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Med. Clin. North Am. · Nov 2024
ReviewMedical Clinics of North America-Periprocedural Antithrombotics: Prophylaxis and Interruption.
Anticoagulation management in the surgical patient requires clinical expertise and careful attention. For patients already receiving anticoagulation for a defined indication (ie, stroke prevention for atrial fibrillation, treatment of venous thromboembolism (VTE), or presence of a mechanical heart valve), understanding how to manage these agents by weighing the risks of thromboembolic events and bleeding is paramount. Additionally, prevention of VTE in the surgical patient involves the identification of patient-specific and procedure-specific risk factors for both VTE and bleeding. With this information, as well as familiarity with the several antithrombotic options available, an appropriate prophylaxis strategy can be employed.
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Med. Clin. North Am. · Nov 2024
ReviewEndocrine Care for the Surgical Patient: Diabetes Mellitus, Thyroid and Adrenal Conditions.
Patients with hyperglycemia, thyroid dysfunction, and adrenal insufficiency face increased perioperative risk, which may be mitigated by appropriate management. This review addresses preoperative glycemic control, makes evidence-based recommendations for the increasingly complex perioperative management of noninsulin diabetes medications, and provides guideline-supported strategies for the perioperative management of insulin, including suggested indications for continuous intravenous insulin. The authors propose a strategy for determining when surgery should be delayed in patients with thyroid dysfunction and present a matrix for managing perioperative stress dose corticosteroids based on the limited evidence available.
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The preoperative care of patients with cancer plays a pivotal role in ensuring optimal outcomes and enhancing the overall quality of life for individuals undergoing surgical interventions. This review aims to provide a comprehensive overview of the key considerations, challenges, and strategies involved in the preoperative management of oncology patients. We delve into the multidisciplinary approach required to address the unique needs of this patient population, emphasizing the importance of collaboration among surgeons, oncologists, anesthesiologists, primary care physicians, hospitalists, and other health care professionals.