Anaes Cases · Preoperative assessment & risk
The high-risk surgical patient — a structured preoperative approach
The high-risk patient long case — the Lee index (3+ factors = 11% cardiac risk), the poor METs (under 4), the CPET (AT under 11), the ESC/ESA algorithm, and the perioperative plan (optimise, monitor, critical-care bed).
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Prompt
A 75-year-old man with a recent MI, COPD, and diabetes needs an elective bowel resection. His functional capacity is poor (cannot climb a flight of stairs). Discuss the preoperative assessment, the risk stratification, and the perioperative plan.
Presentation
A 75-year-old man with a recent MI (3 months ago), COPD (FEV1 50 per cent), insulin-dependent diabetes (HbA1c 8.8 per cent), and a serum creatinine of 200 micromol/L is referred for an elective bowel resection for a colorectal cancer. He cannot climb a flight of stairs without stopping for breath. Discuss the preoperative assessment, the risk stratification, and the perioperative plan.
References3ShowHide
- [1]Lee TH, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 1999.PMID 10477528
- [2]Kristensen SD, et al. 2014 ESC/ESA guidelines on noncardiac surgery: Cardiovascular assessment and management : Are the differences clinically relevant? The European perspective. J Nucl Cardiol, 2017.PMID 27538569
- [3]Older PO, et al. Cardiopulmonary Exercise Testing and Surgery. Ann Am Thorac Soc, 2017.PMID 28511024