The main contraindication to colon surgery would be medical instability. In other words, the surgeon must ask, can this patient tolerate a general anesthetic and the physiologic stress of major surgery? Examples of medical conditions, which would deter the surgeon are recent myocardial infarction, recent stroke, severe COPD, poorly controlled hypertension, and poorly controlled diabetes mellitus. All of these contraindications must be balanced against the indication for colon resection.
Purely elective colon surgery for a benign condition could be postponed for long periods while medical issues are addressed. Conversely, a patient with a life-threatening colonic condition, e.g., perforated diverticulitis with generalized peritonitis may require urgent surgery despite the patient's fragile condition.
It is not uncommon to encounter patients taking anticoagulant medications for a variety of conditions. The most common example would be patients taking coumadin for atrial fibrillation or for deep venous thrombosis or pulmonary embolism. In such cases, the physicians who care for the patient must determine a perioperative plan for the patient's anticoagulation. If the indication for the anticoagulation is questionable, the anticoagulant may be stopped indefinitely. If however, anticoagulation is a necessity, as in protection of a prosthetic heart valve; the following procedure is frequently followed.
The patient is instructed to stop taking coumadin 1 or 2 d prior to admission. The patient is admitted the day prior to surgery and is given intravenous-iv-heparin. The purpose of this regimen is to convert from anticoagulation, which is slow to reverse (coumadin) to anticoagulation, which is rapidly reversible (heparin).
The intravenous heparin is then stopped about 2 h prior to surgery. The heparin is restarted 4-8 h postoperatively depending on the magnitude of the operation. Finally, the patient resumes his/her coumadin prior to discharge.
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