Elective surgery

Summary

Aims

To assess and optimize co-existing medical conditions prior to surgery

To anticipate potential problems, inform the relevant people, and address these prior to admission, e.g. requires ICU (Intensive Care Unit) bed.

History

CARDIOVASCULAR (CVS)

History of hypertension? On antihypertensive medications?

MI: when? What treatment? Cardiology follow-up? If less than six months ago postpone elective surgery

Angina: stable/unstable? How frequently requires GTN spray? Exercise tolerance

Any symptoms of PND (paroxysmal noctural dyspnoea) or orthopnoea? How many pillows does patient sleep on at night?

Past history of rheumatic fever: has patient ever been diagnosed with ‘leaky valve’?

Any symptoms of palpitations, syncope, dizziness, blackouts, unexplained falls?

RESPIRATORY

History of asthma or COPD?

Episodes of bronchitis? If so, how frequently? Sputum production and colour of sputum

Inhalers? Home nebulisers? Home oxygen therapy?

Any hospital admissions with respiratory problems? If so, any ICU admissions?

Severity of dyspnoea, exercise tolerance

Current or past history of smoking? How many per day for how many years?

ABDOMINAL

History of indigestion or reflux?

Any past episodes of jaundice? Does patient have a diagnosis of chronic hepatitis?

Is there a history of renal disease? What is the cause?

Does patient require dialysis? If so, liaise with renal team prior to setting date for surgery

Does patient have a fluid restriction regime?

NEUROLOGICAL

History of CVA?

Epilepsy: how well controlled? When was last seizure?

If frequent seizures, refer to neurology team for optimization preoperatively

Rare conditions, e.g. myasthenia gravis, Duchenne's muscular dystrophy, myotonic dystrophy, multiple sclerosis – take full history of progression of disease.