When do you delay surgery?
|
|
- Gary Collins
- 5 years ago
- Views:
Transcription
1 Cancer BobbieJean Sweitzer, M.D. Director, Anesthesia Perioperative Medicine Clinic Professor of Anesthesia and Critical Care Professor of Medicine University of Chicago I have no disclosures 2 nd leading cause of death in developed world > 500,00 deaths yearly Breast, colon, lung, prostate: >50% of cases & deaths Metastatic burden influences survival Average 5 year survival 68% (>80% for some cancers) Increasing surgical intervention Cancer, other comorbid conditions, chemotherapy and radiation all impact perioperative care Early research suggests possible association between perioperative anesthetic techniques and cancer outcomes When do you delay surgery? Will a delay reduce the chance of cure? Is there an alternative non-surgical treatment? Radiation vs prostatectomy? Can I actually make the patient better/improve their condition? 72 yo male with prostate cancer scheduled for RALP Discovered to have moderate mitral stenosis and pulmonary hypertension during anesthesia preoperative visit Long standing murmur had never been evaluated Cardiology consult: high risk for cardiac complications; high risk for MV replacement After discussion (anesthesiologist, surgeon, cardiologist & patient): Referral to radiation oncologist Preoperative tests are beneficial if: 1) There is a high likelihood abnormalities 2) AND, the abnormality actually increases the risk of anesthesia or surgery 3) AND, the treatment of the abnormality LOWERS the risk 4) AND, waiting to treat the abnormality will not increase risk- especially important for cancer care! 1
2 Erythropoetin use has been associated with worse outcomes in patients with cancer (some tumors have erythropoetin receptors) Metabolic abnormalities Hypercalcemia 10% of patients Squamous cell lung cancer Bony metastases Hypothyroidism Head and neck radiation Always check TFTs Hyponatremia SIADH (lung, pancreas, breast, colon, prostate cancer) Cancer is a hypercoagulable state Venous thromboembolism prophylaxis is indicated for ALL cancer patients Toxicity of Chemotherapy Adriamycin Cardiomyopathy Thalidomide Severe bradycardia Bleomycin Lung toxicity Methotrexate & L-asparginase: Liver dysfunction Cisplatinum: Nephrotoxicity (1/3 of pts affected by a single 50 mg/m 2 dose) Hypomagnesemia 2
3 Toxicity of Radiation Therapy Head & neck irradiation Hypothyroidism Difficult airway Carotid stenoses Risk of TIA/CVA 2X higher Mediastinal, chest wall & left breast irradiation Cardiac disease Conduction abnormalities Coronary artery disease Cardiomyopathies Valvular abnormalities HISTORY OF RADIATION Focus on airway, heart, lungs Head & neck irradiation: Prepare for difficult airway Listen for carotid bruits Carotid dopplers Thyroid function tests Mediastinal, chest wall & left breast irradiation: Echocardiography Electrocardiogram Consider stress testing Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery Kertai MD Am J Med 2004;116:8 Auscultation for systolic murmurs should be done in any patient for whom 8.5 fold a complete increased risk CV database is necessary -Etchells JAMA 1997;277:564 3
4 Cumulative Risks of Death from Ischemic Heart Disease and of at Least One Acute Coronary Event Darby SC. 2013;368:987 QT Prolongation Increased risk of ventricular arrhythmias 16%-36% of cancer patients have baseline ECG abnormalities High rate of comorbid conditions Structural heart disease Hepatic disease Renal disease Electrolyte abnormalities Nausea, vomiting, diarrhea Concomitant use of medications Antiemetics, antifungals, quinolone antibiotics Left ventricular dysfunction Ischemia Hypertension Venous thromboembolism Bradycardia QT prolongation 4
5 What would you do for this patient? 42 yo lawyer, hx of Hodgkin lymphoma as teenager now with breast cancer Severe restrictive lung disease 2 nd pulmonary fibrosis 2 nd radiation and bleomycin; O2 dependent Patient wants bilateral mastectomy and immediate breast reconstruction Pulmonologist: patient too high risk for surgery Surgeon: Will she survive anesthesia? What we did in our preoperative clinic Discussed realistic options/priorities with the patient and the surgeon Arrived at a plan to do a simple mastectomy and axillary node dissection Promised if she did well we would reconsider reconstruction options Scheduled as 2 nd case of the day High thoracic epidural placed under fluoroscopic guidance in our pain clinic Currently- doing more paravertebral blocks OR anesthesia team pre-arranged experience with pulmonary hypertension patients Arranged for postoperative ICU care Patient had uncomplicated course 2006;144: Chest x-rays do not predict postop pulmonary complications (useful for acute problems) PFTs and ABGs in non-lung resection surgeries not predictive of complications Risk reduction strategies Lung expansion maneuvers Incentive spirometry, deep breathing exercises PEEP, CPAP Preoperative beta-agonists and steroids Smoking cessation (even short-term) 5
6 Obstructive Sleep Apnea Increasingly common in all surgical patients Higher risk in patients with head & neck cancers CPAP may be difficult to use after treatments Important to not overlook Nutritional optimization Cancer cachexia (50% of cancer patients) Impaired immune function) Hypoalbuminemia Smoking cessation Pulmonary rehabilitation Pre-habilitation Lung cancer patients-delay of surgery for 2 months improved short-term and long-term outcomes Geriatric patients Frailty ASA alone ASA + frailty RCRI alone RCRI + frailty What should one do? 88 yo rectal bleeding from colon cancer; transfusion dependent Severe aortic stenosis and pulmonary HTN Internist: We have to operate. We can t just let her die What other choice is there? Consider alternative therapies in patients with limited life expectancy Colonic stents Interventional radiology for bleeding Double-balloon enteroscopy for bleeding Hospice care 6
7 Geriatric patients with cancer Willingness to Undergo Treatment Treatment Intensity Health Outcome Desires Treatment Low burden High burden Return to current health Return to current health 98.7% 88.9% Low burden High burden Functional impairment Functional impairment 25.6% 11.2% When do you delay/cancel surgery? Only after discussion with surgeon, patient, oncologist Are there other nonsurgical treatment options? 77 yo with prostate cancer and end-stage COPD referred to urologist who planned prostate resection After discussion with anesthesiologist all agreed to cancel surgery and refer patient for radiation therapy Thoracic surgery patients had much better outcomes than matched cohort for abdominal surgery- Thoracic patients had routine postoperative ICU care Does anesthesia affect long-term outcome of cancer? Tumor surgery is usually associated with release of tumor cells into lymphatic and blood streams Local and metastatic recurrence depends on efficacy of host defenses- natural killer (NK) cells Surgery: Depresses cell mediated immunity (cytotoxic T- cell and NK cell functions Reduces tumor related antiangiogenic factors Increases proangiogenic factors (vascular endothelial growth factor) Anesthesia: Impairs numerous immune functions (neutrophil, macrophage, T-cell and NK cell functions) Opioids: Inhibit cellular and humoral immune function Morphine is proangiogenic (shown to promote breast cancer tumor growth) 7
8 Why might regional anesthesia be better? Attenuates neuroendocrine stress response Reduces endogenous opioid release Reduces amount of exogenous opioid use In rodent model NK cell function better preserved and metastatic load to lungs reduced Summary Comorbidity assessment Cardiac function (less emphasis on ischemic disease) Pulmonary status Renal & liver function Cancer therapy implications Patient and provider discussions regarding goals of therapy Postoperative management ICU care Advance Directive Living will Resuscitation status Discharge planning 8
Which Patients are Too High Risk for Ambulatory Surgery?
Which Patients are Too High Risk for Ambulatory Surgery? BobbieJean Sweitzer, M.D. Director, Anesthesia Perioperative Medicine Clinic Professor of Anesthesia and Critical Care Professor of Medicine University
More informationPre-operative Evaluations. Objectives. General Considerations. FP Consultation Considerations. CV Credits 7/24/2017. Brian Bachelder, MD Akron, Ohio
Pre-operative Evaluations Brian Bachelder, MD Akron, Ohio Objectives Discuss the perioperative cardiopulmonary evaluation and management of patients undergoing non-cardiac surgery Objectively estimate
More informationIndex. Note: Page numbers of article titles are in boldface type
Index Note: Page numbers of article titles are in boldface type A Acute coronary syndrome, perioperative oxygen in, 599 600 Acute lung injury (ALI). See Lung injury and Acute respiratory distress syndrome.
More informationPERIOPERATIVE EVALUATION AND ANESTHETIC MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE FOR NON CARDIAC SURGERY
PERIOPERATIVE EVALUATION AND ANESTHETIC MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE FOR NON CARDIAC SURGERY WHICH PATIENT IS AT HIGHEST RISK? 1. 70 yo asymptomatic patient with history of heart failure
More informationHow to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion
How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion Disclosure Slide No COI and no disclosures. Hospital Mortality rate : is it
More informationI have no disclosures
Preparing patients for out of hospital anesthesia BobbieJean Sweitzer, M.D. Director, Anesthesia Perioperative Medicine Clinic Professor of Anesthesia and Critical Care Professor of Medicine University
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationAMERICAN SOCIETY OF ANESTHESIOLOGISTS ANESTHESIA PRE OPERATIVE SCREENING ASA PHYSICAL STATUS CLASSIFICATION ANESTHESIOLOGISTS
ANESTHESIA PRE OPERATIVE SCREENING CAPA S 37 TH ANNUAL CONFERENCE PALM SPRINGS OCTOBER 5, 2013 ROBERT F. KOPEL, MD, FACP, FCCP HOAG HOSPITAL ASSISTANT CLINICAL PROFESSOR UCLA SCHOOL OF MEDICINE AMERICAN
More informationPre-op Clinical Triad - Pulmonary. Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018
Pre-op Clinical Triad - Pulmonary Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018 Disclosures none Case Mr. G is a 64 year-old man who presents to
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Activated partial thromboplastin time abnormality, perioperative approach to, 104 105 Acute kidney injury, perioperative, 89 99 early
More informationTAVR : Caring for your patients before and after TAVR
TAVR : Caring for your patients before and after TAVR Zubair Ahmed MD FSCAI Interventional Cardiologist Washington Regional Medical Center / Walker Heart Institute What is Aortic Valve Stenosis? AVA ~4
More information4/27/2015. Cardiac Events #1 cause of postoperative complications/ mortality- CHF, complete heart block, MI,
Not intended for medical clearance Identify, document, and evaluate health conditions Medication Management Stratify Risks Optimize conditions within context of surgical illness Recommend measures that
More informationPREOP EVALUATION AND OPTIMIZATION
PREOP EVALUATION AND OPTIMIZATION Barry Perlman, PhD, MD System Lead, Anesthesia Physician Best Practice 4/2012 Disclosure of Potential Financial Conflicts of Interest None But am open to any and all offers
More informationPerioperative Pulmonary Management. Objectives
Citywide Resident Perioperative Medical Consult Conference Perioperative Pulmonary Management Frank Jacono, MD May 5, 2017 Objectives Definition of post-operative pulmonary complications (PPC) Risk factors
More informationFariba Rezaeetalab Associate Professor,Pulmonologist
Fariba Rezaeetalab Associate Professor,Pulmonologist rezaitalabf@mums.ac.ir Patient related risk factors Procedure related risk factors Preoperative risk assessment Risk reduction strategies Age Obesity
More informationConflicts of Interest. Evaluation of Cardiac and Pulmonary Risk in the Preop Patient. Introduction. Risk Assessment. Risk Assessment: RCRI
Evaluation of Cardiac and Pulmonary Risk in the Preop Patient Conflicts of Interest I have no conflicts of interest to declare Adam Schaffer, MD Brigham and Women s Hospital July 20, 2012 Introduction
More informationPreoperative Pulmonary Evaluation. Michelle Zetoony, DO, FCCP, FACOI Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine
Preoperative Pulmonary Evaluation Michelle Zetoony, DO, FCCP, FACOI Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine No disclosures related to this lecture. Objectives Identify pulmonary
More informationECG Workshop. Nezar Amir
ECG Workshop Nezar Amir Myocardial Ischemia ECG Infarct ECG in STEMI is dynamic & evolving Common causes of ST shift Infarct Localisation Left main artery occlusion: o diffuse ST-depression with ST elevation
More informationSurvey of Current Issues in Surgical Anesthesia
Anesthesiology Institute Survey of Current Issues in Surgical Anesthesia November 27 December 1, 2017 The Ritz-Carlton Naples, FL Attend and earn American Board of Anesthesiology MOCA 2.0 TM points! Why
More informationCardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
More informationUCLA General Surgery Residency Program Rotation Educational Policy Goals and Objectives
UPDATED: July 2009 ROTATION: THORACIC SURGERY UCLA General Surgery Residency Program ROTATION DIRECTOR: Mary Maish, M.D. CHIEF OF CARDIAC SURGERY: Robert Cameron, M.D. SITES: UCLA Medical Center - Westwood
More informationProtecting the Lungs
Protecting the Lungs PGA New York 12/07 Disclosures: Peter Slinger MD, FRCPC University of Toronto 58 y.o. Male, Chronic Gallstone Pancreatitis, Open Cholecystectomy 100 pack/year smoker Dyspnea > 1 block
More informationEnhanced Perioperative Management of Older Adults
Enhanced Perioperative Management of Older Adults Bernardo Reyes, MD Assistant Professor of Geriatrics Charles E. Schmidt College of Medicine Disclosures None Interesting Facts Warhol was a sickly child,
More informationIndications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
More informationLooking Outside the Box: Incidental Extracardiac Finding in Echo
Looking Outside the Box: Incidental Extracardiac Finding in Echo Dr. Aijaz Shah Head of Division, Adult Echocardiography Laboratory Prince Sultan Cardiac Centre Riyadh Case 1 17 year old boy presented
More informationSevere Hypertension. Pre-referral considerations: 1. BP of arm and Leg 2. Ambulatory BP 3. Renal causes
Severe Hypertension *Prior to making a referral, call office or Doc Halo, to speak with a Cardiologist or APP to discuss patient and possible treatment options. Please only contact the patient's cardiologist.
More informationPerioperative Cardiovascular Evaluation and Care for Noncardiac. Dr Mahmoud Ebrahimi Interventional cardiologist 91/9/30
Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery Dr Mahmoud Ebrahimi Interventional cardiologist 91/9/30 Active Cardiac Conditions for Which the Patient Should Undergo Evaluation
More informationGoals and Objectives. Assessment Methods/Tools
CA-3 CARDIOVASCULAR ANESTHESIA ROTATION Minneapolis Veterans Administration Medical Center (VAMC) Rotation Site Director: Dr. Karen Ringsred Rotation Duration: 4 weeks Introduction: The patients at the
More informationGeneral surgery. Thyroid surgery. Physiological response to pneumoperitoneum. Bowel resection
General surgery Thyroid surgery Physiological response to pneumoperitoneum Bowel resection General surgery 3.D.9.1 James Mitchell (December 24, 2003) Thyroid surgery Preoperative Assessment Routine, plus
More informationManaging Cardiac & Pulmonary Risk in the Surgical Patient
Managing Cardiac & Pulmonary Risk in the Surgical Patient Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Preoperative Evaluation Guidelines Cardiac: Fleisher
More informationAnjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program Advanced Heart Failure & Cardiac Transplant Temple University
More informationObjectives. Old School. Preoperative Evaluation and Postoperative Complications: Where are the opportunities for risk reduction?
Preoperative Evaluation and Postoperative Complications: Where are the opportunities for risk reduction? Jeffrey Carter, MD RMHMS October 5, 2010 Objectives Understand the preoperative cardiac evaluation
More informationSAUDI FELLOWSHIP TRAINING PROGRAM. Adult Cardiology. Final Written Examination 2019
SAUDI FELLOWSHIP TRAINING PROGRAM Adult Cardiology Final Written Examination 2019 Objectives 1. Determine the trainee has sufficient competency related to the required specialty. 2. Determine the eligibility
More informationOutcome of elderly patients with severe but asymptomatic aortic stenosis
Outcome of elderly patients with severe but asymptomatic aortic stenosis Robert Zilberszac, Harald Gabriel, Gerald Maurer, Raphael Rosenhek Department of Cardiology Medical University of Vienna ESC Congress
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationPerioperative Decision Making The decision has been made to proceed with operative management timing and site of surgery the type of anesthesia preope
Preoperative Evaluation In Endocrine Disorders Dr Nahid Zirak 2012 Perioperative Decision Making The decision has been made to proceed with operative management timing and site of surgery the type of anesthesia
More informationQuality Measures MIPS CV Specific
Quality Measures MIPS CV Specific MEASURE NAME Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy CAHPS for MIPS Clinician/Group Survey Cardiac Rehabilitation Patient Referral from
More informationContraindications to time critical surgery; when not to proceed from the perspective of: The Physician A/Prof Peter Morley
Contraindications to time critical surgery; when not to proceed from the perspective of: The Physician A/Prof Peter Morley British Journal of Surgery 2013; 100: 1045 1049 The risk of 30 day mortality
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationAn Overview of Perioperative Medicine 2015: From Outpatient Preoperative Assessment to Inpatient Postoperative Care
An Overview of Perioperative Medicine 2015: From Outpatient Preoperative Assessment to Inpatient Postoperative Care WEDNESDAY, OCTOBER 7, 2015 6:00 a.m. Continental Breakfast and Registration 7:30 a.m.
More informationPre-op Risk Assessment. Hal Blanks MD FACC
Pre-op Risk Assessment Hal Blanks MD FACC Objectives: Identify and manage patients with known or suspected CAD and other cardiac diseases who are at risk of cardiac complications during noncardiac surgery.
More informationDISCLOSURE. Echocardiography in Systemic Diseases: Questions. Relevant Financial Relationship(s) None. Off Label Usage None 5/7/2018
Echocardiography in Systemic Diseases: Questions Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate
More informationConflicts of Interest
Anesthesia for Major Abdominal Cancer Resection John E. Ellis MD Adjunct Professor University of Pennsylvania johnellis1700@gmail.com Conflicts of Interest 1 Upper Abdominal Surgery Focus on oncologic
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationAn Overview of Perioperative Medicine 2014: From Outpatient Preoperative Assessment to Inpatient Postoperative Care
An Overview of Perioperative Medicine 2014: From Outpatient Preoperative Assessment to Inpatient Postoperative Care WEDNESDAY, OCTOBER 22, 2014 6:00 a.m. Continental Breakfast and Registration 7:30 a.m.
More informationPERIOPERATIVE ANESTHETIC RISK IN THE GERIATRIC PATIENT
PERIOPERATIVE ANESTHETIC RISK IN THE GERIATRIC PATIENT Susan H. Noorily, M.D. Clinical Professor of Anesthesiology Medical Director University Preoperative Medicine Center IMPORTANCE Half of all currently
More informationSUPPLEMENTAL MATERIAL. Supplemental digital content 1, Appendix 1. Ischemic symptoms and electrocardiography
SUPPLEMENTAL MATERIAL Supplemental digital content 1, Appendix 1. Ischemic symptoms and electrocardiography findings 1. Ischemic symptoms included any of the following: chest discomfort, arm discomfort,
More informationAnesthesia Preoperative Patient History
Anesthesia Preoperative Patient History Please Complete and BRING WITH YOU to Your Anesthesia Appointment Patient Name: Date of Birth: Phone Number: Kind of Surgery You are Having: Date of Your Surgery:
More informationClinical Fellowship Vascular/Thoracic Anesthesia
Anesthesia and Perioperative Medicine Western University Vascular/Thoracic Fellowship Program Director Dr. George Nicolaou Please visit the Vascular/Thoracic Anesthesia Fellowship site for most up-to-date
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adverse drug events, polypharmacy and perioperative considerations in elderly patients, 377 389 Age, and risk of postoperative urinary retention,
More informationTerry Clifford, MSN, RN, CPAN, CAPA Nurse Manager Perioperative Services Portland, Maine, USA
Terry Clifford, MSN, RN, CPAN, CAPA Nurse Manager Perioperative Services Portland, Maine, USA Identify and optimize conditions that increase periop morbidity and mortality OR Detect abnormalities that
More informationCardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center
The fellowship in Cardiothoracic Anesthesia at the Beth Israel Deaconess Medical Center is intended to provide the foundation for a career as either an academic cardiothoracic anesthesiologist or clinical
More information7. Echocardiography Appropriate Use Criteria (by Indication)
Criteria for Echocardiography 1133 7. Echocardiography Criteria (by ) Table 1. TTE for General Evaluation of Cardiac Structure and Function Suspected Cardiac Etiology General With TTE 1. Symptoms or conditions
More informationValue of echocardiography in chronic dyspnea
Value of echocardiography in chronic dyspnea Jahrestagung Schweizerische Gesellschaft für /Schweizerische Gesellschaft für Pneumologie B. Kaufmann 16.06.2016 Chronic dyspnea Shortness of breath lasting
More informationKAPC Practice Guideline Title: Presurgical Testing Guidelines. Date Approved: 2/13/2017
KAPC Practice Guideline Title: Presurgical ing Guidelines Date Approved: 2/13/2017 Policy Overview: Several specialty societies, most notably the American Society of Anesthesiologists and the American
More informationPRE-OP H&P S: WHAT REALLY MATTERS
1 2 PRE-OP H&P S: WHAT REALLY MATTERS Jenikka Soyring, DNP Why Pre-op Assessments Reduce risk for cardiac, pulmonary and infectious complications Not meant to clear for surgery It is to evaluate and implement
More informationAn Overview of Perioperative Medicine 2015: From Outpatient Preoperative Assessment to Inpatient Postoperative Care
An Overview of Perioperative Medicine 2015: From Outpatient Preoperative Assessment to Inpatient Postoperative Care WEDNESDAY, OCTOBER 7, 2015 6:00 a.m. Continental Breakfast and Registration 7:30 a.m.
More informationPerioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease
2012 대한춘계심장학회 Perioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease 울산의대울산대학병원심장내과이상곤 ECG CLASS IIb 1. Preoperative resting 12-lead ECG may be reasonable in patients with
More informationCardiotoxicity: The View of the Cardiologist
Cardiotoxicity: The View of the Cardiologist Dr. Yael Peled, Cardio-Oncology Interactions: 1.Cardiotoxicity following chemotherapy 2. Co existence of cancer and CVD Aging & common risk factors cardiac
More informationCHEST PAIN CDU INCLUSION CRITERIA
CHEST PAIN CDU INCLUSION CRITERIA No clinical criteria for ACS Stable vital signs Initial ECG and cardiac biomarkers not consistent with ACS Low to intermediate ACS risk (HEART score 0-6) [Ref 1, 2] Plan
More informationMitral Regurgitation
UW MEDICINE PATIENT EDUCATION Mitral Regurgitation Causes, symptoms, diagnosis, and treatment This handout describes mitral regurgitation, a disease of the mitral valve. It explains how this disease is
More informationThe Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery
+ The Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery Elif GEZGINCI Gulhane Military Medical Academy School of Nursing Ankara 1 + 2 PREOPERATİVE + Preoperative (Patient
More informationACOFP 55th Annual Convention & Scientific Seminars. How Complicated is Your Panel? Effective Risk Coding in Primary Care. Alison Mancuso, DO, FACOFP
8 ACOFP 55th Annual Convention & Scientific Seminars How Complicated is Your Panel? Effective Risk Coding in Primary Care Alison Mancuso, DO, FACOFP How Complicated is Your Panel?: Effective Risk Coding
More informationOrthopedic Surgery for Adults with Cerebral Palsy- Medical Considerations. Disclosures. Objectives. Adults with Cerebral Palsy
Orthopedic Surgery for Adults with Cerebral Palsy- Medical Considerations American Academy for Cerebral Palsy and Developmental Medicine, 2013, IC 6 Garey Noritz, MD, FAAP, FACP Nationwide Children s Hospital
More informationClinical indications for positron emission tomography
Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will
More informationDysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics
Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise
More informationCanadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC. DO's and DON'Ts: Reducing unnecessary perioperative investigations
Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC DO's and DON'Ts: Reducing unnecessary perioperative investigations Emmanuelle Duceppe, MD FRCPC General Internal Medicine University
More informationPLEASE LET US KNOW YOUR REASON FOR TODAY S VISIT : CURRENT MEDICATIONS (WITH DOSAGE) PLEASE INCLUDE VITAMINS AND HERBAL MEDICATIONS:
1 NAME: DATE OF BIRTH PLEASE LET US KNOW YOUR REASON FOR TODAY S VISIT : CURRENT MEDICATIONS (WITH DOSAGE) PLEASE INCLUDE VITAMINS AND HERBAL MEDICATIONS: PAST MEDICAL HISTORY (YOUR MEDICAL HISTORY) :
More informationPET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET
Positron Emission Tomography (PET) When calling Anthem (1-800-533-1120) or using the Point of Care authorization system for a Health Service Review, the following clinical information may be needed to
More informationNothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
More informationBreast Cancer and the Heart
Breast Cancer and the Heart Anne H. Blaes, M.D., M.S. Associate Professor University of Minnesota Hematology/Oncology Director, Adult Cancer Survivor Clinic No disclosures Objectives Discuss cardiac complications
More informationAtrial Fibrillation and Heart Failure: A Cause or a Consequence
Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November
More informationFaster Cancer Treatment Indicators: Use cases
Faster Cancer Treatment Indicators: Use cases 2014 Date: October 2014 Version: Owner: Status: v01 Ministry of Health Cancer Services Final Citation: Ministry of Health. 2014. Faster Cancer Treatment Indicators:
More informationClinical Controversies in Perioperative Medicine
Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Cardiac Evaluation: New Guidelines A 70-y.o. man with progressive
More informationPrinciples of Surgical Oncology ศาสตราจารย นายแพทย ธนพล ไหมแพง
Principles of Surgical Oncology ศาสตราจารย นายแพทย ธนพล ไหมแพง Surgery is the oldest treatment for cancer and, until recently, was the only treatment that could cure patients with cancer. Ancient history
More informationCurrent treatment of Aortic Aneurysms and Dissections. Adam Keefer, MD, FACS Sean Hislop, MD, FACS
Current treatment of Aortic Aneurysms and Dissections Adam Keefer, MD, FACS Sean Hislop, MD, FACS Patient 1 69 year old well-educated man with reoccurring pain in his upper abdomen and a pulsatile mass.
More informationPerioperative Medicine 2017 November 3, Disclosures
Perioperative Medicine 2017 November 3, 2017 Scott Marsal, MD MSc FACP Chief, Medicine Division Medical Director, Quality & Patient Safety Providence St. Vincent Medical Center Disclosures No conflicts
More information8/28/2018. Pre-op Evaluation for non cardiac surgery. A quick review from 2007!! Disclosures. John Steuter, MD. None
Pre-op Evaluation for non cardiac surgery John Steuter, MD Disclosures None A quick review from 2007!! Fliesheret al, ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and are for Noncardiac
More information2018 ABG QCDR Measure Specifications. (changes to old measures from 2017 in red font)
2018 ABG QCDR Measure Specifications (changes to old measures from 2017 in red font) Calculations Reporting Rate = Performance Met + Performance Not Met + Denominator Exceptions + Denominator Exclusions
More informationAppropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology (scores listed by Appropriate Use rating)
Appropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology (scores listed by Appropriate Use rating) Table 1: Appropriate indications (median score 7-9) Indication
More informationby Brian Wolfe, MD Assistant Professor of Medicine, University of Colorado Denver
Perioperative Cases by Brian Wolfe, MD Assistant Professor of Medicine, University of Colorado Denver 75 yo for left knee arthroplasty Problem List Social Hx: obesity uses a walker diabetes because of
More informationASE 2011 Appropriate Use Criteria for Echocardiography
ASE 2011 Appropriate Use Criteria for Echocardiography Table 1. TTE for General Evaluation of Cardiac Structure and Function 1 2 Suspected Cardiac Etiology General With TTE Symptoms or conditions potentially
More informationFrederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006.
Frederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006 Introduction Laparoscopic surgery started in the mid 1950s. In recent
More informationOutline. Major variables contributing to airway patency/collapse. OSA- Definition
Outline Alicia Gruber Kalamas, MD Associate Clinical Professor of Anesthesia & Perioperative Care University of California, San Francisco September 2011 Definition Pathophysiology Patient Risk Factors
More informationCost and Prevalence of A fib. Atrial Fibrillation: Guideline Directed Treatment. Prevalence of A Fib. Risk Factors for A Fib. Risk Factors for A Fib
Atrial Fibrillation: Guideline Directed Treatment Melissa Wendell, FNP-C, MSN Heart Failure - Lead Nurse Practitioner, Aspirus Wausau Hospital and Aspirus Cardiology Cost and Prevalence of A fib 33.5 million
More informationBeta Blockade: Protection or Panacea
Beta Blockade: Protection or Panacea Jason Axt Jason s Recommendations Perioperative β Blockade (BB) If on BB stay on If Vascular Sx + documented ischemia - start. 2+ risk factors - start Use in isolated
More informationCardio-Oncology: Advancing Cardiovascular Care of the Oncology Patient
Cardio-Oncology: Advancing Cardiovascular Care of the Oncology Patient Vijay U. Rao, MD, PhD, FACC, FASE Franciscan Physician Network Indiana Heart Physicians Director, Franciscan Health Inpatient Heart
More informationBY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Cancer is a group of more than 100 different diseases that are characterized by uncontrolled cellular growth,
More informationTiming of Surgery After Percutaneous Coronary Intervention
Timing of Surgery After Percutaneous Coronary Intervention Deepak Talreja, MD, FACC Bayview/EVMS/Sentara Outline/Highlights Timing of elective surgery What to do with medications Stopping anti-platelet
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acetaminophen, for geriatric surgical patients, 569 570 Acute kidney injury, critical care issues in geriatric patients with, 555 556
More informationChest Pain. Dr. Amitesh Aggarwal. Department of Medicine
Chest Pain Dr. Amitesh Aggarwal Department of Medicine BACKGROUND Approx 5% of all ED visits 15 % - AMI 25-30 % - Unstable angina 50-55 % - Other conditions Atypical presentations common 2% of patients
More informationDisclosures. May 15 th, Influenza Vaccination as Secondary Prevention for Acute Coronary Events Where do we need to go in clinical practice?
Influenza Vaccination as Secondary Prevention for Acute Coronary Events Where do we need to go in clinical practice? May 15 th, 2014 Robi Goswami, MD Cardiologist Piedmont Heart Institute Disclosures None
More informationAbdominal Aortic Aneurysm - Part 1. Learning Objectives. Disclosure. University of Toronto Division of Vascular Surgery
University of Toronto Division of Vascular Surgery Abdominal Aortic Aneurysm - Part 1 Dr Mark Wheatcroft & Dr Elisa Greco Vascular Surgeon, St Michael s Hospital, Toronto & University of Toronto Disclosure
More informationPERIOPERATIVE CARDIAC RISK ASSESSMENT. Divya Gollapudi, MD
PERIOPERATIVE CARDIAC RISK ASSESSMENT Divya Gollapudi, MD Clinical Assistant Professor Hospital Medicine Program Division of General Internal Medicine Harborview Medical Center None Disclosures Objectives
More informationBenefits and Harms of Routine Preoperative Testing: A Comparative Effectiveness Review
Benefits and Harms of Routine Preoperative Testing: A Comparative Effectiveness Review Brown Evidence- based Practice Center, Brown University School of Public Health Ethan M. Balk, MD, MPH Amy Earley,
More informationExceptions to the Rules: Abdominal and Thoracic Aneurysms
Exceptions to the Rules: Abdominal and Thoracic Aneurysms Jason Bayne MD, FRCSC Vascular Surgery Jewish General Hospital Assistant Professor, Program Director McGill University Objectives Risk factors
More informationSafe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam
Safe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam By Sarmad Aji, MD., FACS. A comprehensive review of the most commonly asked questions on the American Board of Surgery
More informationLung Cancer - Suspected
Lung Cancer - Suspected Shared Decision Making Lung Cancer: http://www.enhertsccg.nhs.uk/ Patient presents with abnormal CXR Lung cancer - clinical presentation History and Examination Incidental finding
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationPreoperative Evaluation: Patients with Cardiac Disease
Advances in Internal Medicine 2012 Preoperative Evaluation: Patients with Cardiac Disease Mary O. Gray, MD Professor of Medicine UC San Francisco Circulation 2007:100:e418-e500 (1) Cardiac Risk Assessment
More information