Term 5 Week 8 (w/c 11/03/12)
Good morning class
You are asked to evaluate a patient pre-operatively. They have multiple cardiovascular risk factors including a significant smoking history and hypertension.
16 weeks ago they were hospitalised with central chest pain and they tell you they spent some time in the coronary care unit. You are aware that they are awaiting cancer surgery.
How will you go about assessing the patient pre-operatively?
Thanks for the input so far. Quite correctly most people were concerned regarding the specific treatment the patient had received including any drug treatment instigated. More information is revealed as you get hold of the medical records
68 year old female. Weight approximately 55 kg. Smoker. Has avoided medical attention until recently
Presented with cardiac sounding chest pain several weeks ago. ECG showed changes in the anterolateral leads with coronary angiography showing occlusion of the left circumflex as well as more diffuse disease in other vessels.
She received timely PCI and the lesion was stented with a bare metal stent. She has been started on Aspirin, clopidogrel and an ace-inhibitor.
She has been relatively symptom free during her recovery but can only just manage 1 flight stairs due to shortness of breath (husband says this is longstanding). She was noticed to be anaemic and investigation revealed a caecal tumor.
She is listed to have a laparoscopic right hemicolectomy in the next few days.
She is extremely anxious and wants to know her perioperative risk? What will you tell her?
Thankyou for the suggestions so far regarding her risk stratification.
Additional investigation results include an ECG showing sinus rhythm, right axis deviation and prominent p waves inferiorly. Echocardiogram suggests pulmonary hypertension, with left ventricular hypertrophy and reasonable LV systolic function. Pulmonary function tests confirm an obstructive pattern with FEV1 <50% predicted (mod – severe)
Time to decide an anaesthetic plan?
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