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Category: Perioperative Care

Preoperative Testing ?>

Preoperative Testing

Preoperative Testing Introduction Medical consultants are generally asked to assess preoperative risk in most patients who are to undergo surgery. The focus of discussion in this article applies to healthy people who are to undergo an elective surgical procedure. Despite a low risk of perioperative complications, the use of laboratory tests before surgery became ingrained in clinical practice not only across the United States but also across the world in the latter half of the 20th century. At that time,…

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Perioperative Management of the Patient With Chronic Renal Failure ?>

Perioperative Management of the Patient With Chronic Renal Failure

Perioperative Management of the Patient With Chronic Renal Failure Introduction Chronic renal failure (CRF), or more appropriately chronic kidney disease (CKD), refers to a decline in the glomerular filtration rate (GFR) caused by a variety of diseases, such as diabetes, glomerulonephritis, and polycystic kidney disease. Patients with CKD have a high prevalence of hypertension. Whether hypertension is a cause or a result of CKD remains debatable. CKD may be categorized as mild (GFR of 60-89 mL/min/1.73 m2), moderate (GFR of…

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Perioperative Management of the Geriatric Patient ?>

Perioperative Management of the Geriatric Patient

Perioperative Management of the Geriatric Patient Introduction Advances in surgical and anesthetic techniques combined with sophisticated perioperative monitoring are factors that have contributed to an expanding number of older adults undergoing surgery. A preoperative assessment is useful to identify factors associated with increased risks of specific complications and to recommend a management plan that minimizes the risks. Each person should be assessed individually, and judgments should be based on an individual’s problem and physiologic status, not on age alone. According…

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Perioperative Management of the Female Patient ?>

Perioperative Management of the Female Patient

Perioperative Management of the Female Patient Introduction Caring for women who are about to undergo gynecologic surgery is challenging. The current climate in medicine is fraught with issues involving quality of care, professional liability, availability of information via the Internet, patient input into her care, and dwindling health care dollars. Technological advances in laparoscopy, urogynecology, and female pelvic medicine, and the rapid introduction of surgical devices have created conflict between the surgeon’s desire to provide the most current care and…

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Perioperative Cardiac Management ?>

Perioperative Cardiac Management

Perioperative Cardiac Management Background The worldwide elderly population with its associated health concerns is expanding rapidly. Globally, the proportion of individuals older than 80 years currently averages 5%. In the developed world, almost 15% of individuals will be older than 80 years in 2020; the proportion is expected to increase to 25% by 2050. This aging population has associated comorbidities; consequently, clinicians are often asked to evaluate the preoperative risk status of this high-risk population. The cardiovascular systems of patients…

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Perioperative Anticoagulation Management ?>

Perioperative Anticoagulation Management

Perioperative Anticoagulation Management Definition of Problem In performing noncardiac surgery on patients on anticoagulation, the major concern is when it is safe to perform surgery without increasing the risk of hemorrhage or increasing the risk of thromboembolism (eg, venous, arterial) after discontinuing treatment. In treating patients on long-term coumadin perioperatively, consider the risks of hemorrhage or thromboembolism versus the benefit from the operation. When considering noncardiac surgery, these factors and the need to weigh the risk of hemorrhage against that…

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