Pre-operative Evaluation

Question 1

what should be done if a patient is unable to meet 4 METs?

Answer 1

stress testing

• exercise ECG testing with perfusion imaging
• if they cannot exercise-consider pharmacologic stress test
• if reversible perfusion defect is seen the probability of post operative MI is higher with reversible defect
• consult wiht cardiology if they need revascularization prior to the surgery

Question 2

what are some contraindications to surgery?

Answer 2

• recent myocardial infarction < 60 days
• unstable angina
• class III OR IV angina
• decompensated heart failure
• symptomatic moderate or severe valvular heart disease

Question 3

what tests are commonly ordered pre-op?

Answer 3

• Hgb- if > 65, or if there will be significant blood loss
• Cr if > 50 or if there is renal disease
• pregnancy test- in all reproductive age women
• ECG if > 50 years or vascular operations, hx of hypertension, cardiac disease etc

Question 4

drugs that can be continued in pre-op?

Answer 4

• cardiac (b-blockers, antiarrhythmics)
• pulmonay (inhalers or nebulizers)
• neuro (anitconvulsants, psychiatric meds)
• vascular (antihypertensives)
• take w/ a sip of water the morning of the operation even if NPO