Clinics in geriatric medicine
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Clin. Geriatr. Med. · Nov 2008
ReviewEvaluation and management of the elderly patient at risk for postoperative delirium.
Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.
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Clin. Geriatr. Med. · Nov 2008
ReviewPerioperative cardiac evaluation: assessment, risk reduction, and complication management.
Perioperative cardiac complications are among the most feared outcomes after surgery. Using evidence-based guidelines and expert opinion, physicians can perform a risk assessment and decide whether further cardiac testing, medical therapy, or coronary intervention is necessary to optimize the patient's medical condition prior to surgery. This article reviews the major concepts and recommendations from the ACC guidelines for preoperative cardiac evaluation and perioperative management to reduce risk. Medical management of the major postoperative cardiac complications is also discussed.
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Postoperative pulmonary complications are an important source of surgical morbidity. In this paper, the authors review recent studies that shed light on emerging risk factors, a multifactorial index for respiratory failure, and the value of specific risk reduction strategies. Novel risk factors include advanced age, congestive heart failure, pulmonary hypertension, and obstructive sleep apnea. Important risk reduction strategies include postoperative lung expansion maneuvers, the selective use of nasogastric tubes, epidural analgesia, and inspiratory muscle training.