Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Section I Basic sciences
- Section II Anaesthesia and peri-operative care for surgical specialties
- Section III At a glance
- Chapter 22 Scoring systems
- Chapter 23 Modes of mechanical ventilation
- Chapter 24 Fluids
- Chapter 25 Coagulation
- Chapter 26 Pre-operative echocardiography
- Chapter 27 Common drugs and doses
- Chapter 28 Physiology and risk in special circumstances
- Chapter 29 Medicolegal aspects of consent
- Chapter 30 Nerve injury
- Chapter 31 Pre-operative investigations
- Chapter 32 Enhanced recovery
- Chapter 33 Post-operative cognitive dysfunction
- List of abbreviations
- Index
- References
Chapter 31 - Pre-operative investigations
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- List of contributors
- Foreword
- Section I Basic sciences
- Section II Anaesthesia and peri-operative care for surgical specialties
- Section III At a glance
- Chapter 22 Scoring systems
- Chapter 23 Modes of mechanical ventilation
- Chapter 24 Fluids
- Chapter 25 Coagulation
- Chapter 26 Pre-operative echocardiography
- Chapter 27 Common drugs and doses
- Chapter 28 Physiology and risk in special circumstances
- Chapter 29 Medicolegal aspects of consent
- Chapter 30 Nerve injury
- Chapter 31 Pre-operative investigations
- Chapter 32 Enhanced recovery
- Chapter 33 Post-operative cognitive dysfunction
- List of abbreviations
- Index
- References
Summary
Introduction
Among the many roles that the anaesthetist has, risk assessment and risk modification are perhaps the most important. In order to manage peri-operative risk, the anaesthetist must have an understanding of the impact of co-existing medical conditions and concomitant drug therapy on normal physiology, and an appreciation of their likely interactions with both anaesthesia and surgery. When conducted effectively, pre-operative assessment decreases the risk of cancellations on the day of surgery and has the potential to reduce peri-operative morbidity and mortality.
Taking a detailed medical history and performing a competent physical examination remain the most efficient and effective ways of predicting and detecting significant co-morbid conditions. Pre-operative investigations should therefore be considered an adjunct to, rather than a substitute for, basic medical vigilance. Many pre-operative clinical investigations are justifiable on the grounds that they aid diagnosis (e.g. CT scan), assist in surgical planning (e.g. coronary angiography), permit more accurate risk stratification (e.g. exercise testing), guide risk-modification strategies or provide a ‘baseline’ before major surgery. A significant number of tests, however, are ordered ‘routinely’ without any clinical indication or justification.
- Type
- Chapter
- Information
- A Surgeon's Guide to Anaesthesia and Peri-operative Care , pp. 302 - 309Publisher: Cambridge University PressPrint publication year: 2014