Factors Affecting Cardiac Risk

Previous and Current Cardiovascular Disease In the United States, approximately 30 of the 27 million patients scheduled to undergo anesthesia for surgical procedures yearly are known to have risk factors for coronary artery disease (CAD).8 Given that cardiovascular disease is the leading cause of death in the United States,9 it is not altogether surprising that cardiovascular factors account for the greatest proportion of operative risk. Significant cardiovascular risk factors include angina...

Infection Control Practitioners

The reshaping of hospitals because of cost constraints will have an effect on the work of infection control practitioners. Already, some institutions have regrouped responsibilities and changed the role of these professionals. Given the accreditation mandate, the need to continue an active program may be reviewed. Many training pro grams are available to assist with professional and organizational development (see below), and the APIC certification program supports continuous professional...

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Climbing one flight of stairs Walking up a hill Walking on level ground at rate > 4 mph Running a short distance More strenuous household chores (e.g., scrubbing floors, moving furniture) Moderate recreational activities (e.g., hiking, dancing, golf) Strenuous athletic activities (e.g., tennis, running, basketball, patients older than 50 years, but it is 3.1 in comparable vascular surgery patients, in whom the prevalence of asymptomatic CAD is predictably high.17 Patients who are able to...

Premedication

Premedication is an important adjunct to local and regional general anesthesia see Table 7 .19 It can facilitate performance of the procedure by alleviating fear and anxiety, supplementing analgesia, reducing gastric acidity and volume, reducing oral and airway secretions, decreasing histaminic effects in patients with multiple allergies, limiting postoperative nausea and vomiting (PONV), and controlling infection. On the other hand, premedication, especially with narcotics, can also delay...

Table 1 Relative Contraindications to Outpatient Surgery

Procedures with an anticipated significant blood loss Procedures associated with significant postoperative pain Procedures necessitating extended postoperative I.V. therapy ASA class IV or III if the systemic disease is not under control, as with unstable angina, asthma, diabetes mellitus, and morbid obesity Known coagulation problems, including the use of anticoagulants Inadequate abillity or understanding on the part of caretakers with respect to requirements for postoperative care Generally...