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 diagnosis biomarkers, 94 epidemiology, 90 prognosis, 94 renal protection strategies, 94 96 risk stratification based on surgical setting, 90 94 Addiction. See Substance abuse. Affordable Care Act, shared decision-making in, 36 Age, and risk of postoperative pulmonary complications, 76 Aging. See Geriatric patients. Alcohol abuse, preoperative evaluation and perioperative considerations, 203 205 American College of Cardiology, guidelines on perioperative cardiovascular evaluation before noncardiac surgery, 59 70 American Heart Association, guidelines on perioperative cardiovascular evaluation before noncardiac surgery, 59 70 Analgesia, type of, and risk of postoperative pulmonary complications, 79 Anemia, preoperative, 127 141 definition, 127 epidemiology, 128 evaluation for, 131 135 history, 132 laboratory evaluation, 135 signs, symptoms, and physical examination, 133 in patients with sickle cell disease, 137 138 patient blood management, 138 perioperative blood transfusions for, and postoperative outcomes, 130 131 mortality, 130 131 postoperative complications, 131 preoperative optimization of patients and anemia evaluation, 128 130 treatment of, 136 137 nutritional deficiency, 136 red cell transfusion, 137 stimulation of erythropoiesis, 136 137 Anesthesia, effects of surgery and, during pregnancy, 214 218 fetal, 215 218 maternal, 214 215 non-operating room, 223 240 adding value of anesthesiologists, 225 226 anesthesia vs procedural sedation, 226 229 Anesthesiology Clin 34 (2016) 241 254 http://dx.doi.org/10.1016/s1932-2275(16)00028-8 anesthesiology.theclinics.com 1932-2275/16/$ see front matter ª 2016 Elsevier Inc. All rights reserved.
242 Index Anesthesia (continued) assessment of environment for, 229 230 challenges of, 224 225 diagnostic testing, 235 237 future directions, 237 patient assessment for, cardiovascular, 231 233 gastrointestinal, 234 obstetric, 234 235 pulmonary, 233 234 renal, 234 pre-procedural medication management, 237 procedural assessment, 235 quality assurance, 225 type of, and risk of postoperative pulmonary complications, 79 Anesthesiologists, adding value as, with non-operating room anesthesia, 225 226 Anticoagulant therapy, perioperative management of patients on chronic, 119 123 with target-specific anticoagulants, 121 123 Antiplatelet management, before noncardiac surgery in patients with cardiac disease, 66 68 Arterial blood gas, chest, to assess risk of postoperative pulmonary complications, 81 82 Asthma, and risk of postoperative pulmonary complications, 75 Automatic implantable cardioverter defibrillator (AICD), perioperative management of patients with, 186 190 Autonomic dysfunction, in preoperative evaluation of patients with diabetes mellitus, 157 159, 164 cardiac neuropathy, 159 gastroparesis, 158 159 Autonomy, DNR orders in the operating room, 39 B Behavioral assessment, preoperative, in geriatric patients, 172 Beneficence, DNR orders in the operating room, 39 Bernard-Soulier disease, perioperative management of, 114 Beta-blockade, indications for postoperative, in patients with cardiac disease, 66 68 Biomarkers, for risk of perioperative acute kidney injury, 94 Bleeding risk, assessment of perioperative, 102 Bleeding time, assessment of perioperative, 105 Blood glucose testing, preoperative, 51 52 Blood transfusions, perioperative, in patients with anemia, 130 131 mortality, 130 131 patient blood management, 138t postoperative complications, 131 red cell transfusion, 137 allogeneic, 137 autologous, 137 C Cannabinoids, preoperative evaluation and perioperative considerations, 205 206
Cardiac disease, patients with, preoperative assessment for noncardiac surgery, 59 70 approach to the patient, 64 choice of diagnostic test, 64 66 clinical assessment, 60 63 coronary artery disease, interventions for patients with, 66 68 importance of exercise tolerance, 63 64 importance of the operative procedure, 63 Cardiac evaluation, preoperative, in geriatric patients, 172 173 Cardiac neuropathy, in preoperative evaluation of patients with diabetes mellitus, 159 Cardiovascular assessment, preoperative, for non-operating room anesthesia, 231 233 Cardiovascular implantable electronic device (CIED), assessment and perioperative management of patients with, 186 190 Chest radiograph, to assess risk of postoperative pulmonary complications, 81 Chronic kidney disease, risk of perioperative bleeding in, 114 115 Chronic obstructive pulmonary disease, and risk of postoperative pulmonary complications, 74 75 Clinics, preoperative, 1 15 benefits and outcomes, 4 5 developing programs for, 5 6 history and background, 2 4 identifying resources, 9 12 performance management and quality improvement, 12 visit volume and space, 10 12 workforce, 9 10 scope of, 6 7 specific services delivered, 8 9 algorithms, 9 communication, 9 in-person clinic visits, 9 phone calls, 9 triage, 8 9 Coagulation disorders, perioperative approach to, 101 126 activated partial thromboplastin time abnormality, 104 105 bleeding risk assessment, 102 bleeding time, 105 chronic kidney disease, 114 115 coagulation pathway assessment, 102 104 hemophilia and von Willebrand disease, 105 108 platelet count assessment, 108 110 platelet dysfunction, 114 inherited disorders of, 114 platelet function testing, 114 special hematologic considerations, 115 117 glucose-6-phosphate dehydrogenase deficiency, 116 sickle cell anemia, 115 thrombocytosis, 116 117 thrombocytopenia, 110 113 Coagulation studies, preoperative, 52 53 Cocaine abuse, preoperative evaluation and perioperative considerations, 205 206 Consultations, preoperative medical, 17 33 coordination of, 24 25 Index 243
244 Index Consultations (continued) cost of, 23 24 current use of, 19 23 medicolegal aspects, 25 26 outcomes and, 26 28 purpose of, 18 19 recommendations, 28 29 Coronary artery disease, interventions before noncardiac surgery in patients with documented, 66 68 Coronary revascularization, before noncardiac surgery in patients with documented coronary artery disease, 66 68 D Decision-making, shared, as a perioperative ethical issue, 35 38 Affordable Care Act, 36 barriers and motivators, 37 evidence for, 36 37 Deep brain stimulators, perioperative management of patients with, 193 Delirium, preoperative, in geriatric patients, 174 176 Dependent functional status, and risk of postoperative pulmonary complications, 78 Diabetes mellitus, preoperative evaluation of patients with, 155 169 autonomic dysfunction, 157 159, 164 cardiac neuropathy, 159 gastroparesis, 158 159 classification, 156 157 comorbidities associated with, 159 medication considerations, 160, 162 163 physical examination considerations for anesthesiologist, 160 166 airway, 160 anesthesia plan, 161, 164 cardiovascular, 161 continuous subcutaneous insulin infusion (pumps), 165 166 instructions, 161 intraoperative glycemic monitoring, 164 laboratory testing, 161 postoperative glycemic monitoring, 164 165 surgical site infection screening, 161 related complications, impact on perioperative risk, 157 Diagnostic testing, preoperative, for non-operating room anesthesia, 235 237 preoperative, for noncardiac surgery in patients with cardiac disease, 64 66 Diaphragmatic nerve stimulators, perioperative management of patients with, 195 Disseminated intravascular coagulation, perioperative management of, 112 Do not resuscitate (DNR) orders, in the operating room, 38 41 reconciliation of these two perspectives, 38 40 autonomy, 39 beneficence, 39 biomedical ethical principles, 39 justice and fairness, 39 40 nonmaleficence, 39 responsibility for discussing and clarifying, 40 41
Index 245 Drug abuse. See Substance use disorder. Drug-induced thrombocytopenia, perioperative management of, 112 E Echocardiography, to assess risk of postoperative pulmonary complications, 82 Elderly. See Geriatric patients. Electrocardiogram, in preoperative testing, 46 48 Electromagnetic interference, with cardiovascular implantable electronic devices, 187 189 Emergency surgery, and risk of postoperative pulmonary complications, 80 Erythropoiesis, stimulation of, for treatment of preoperative anemia due to, 136 137 Ethical issues, perioperative, 35 42 do not resuscitate in the operating room, 38 41 reconciliation of these two perspectives, 38 40 responsibility for discussing and clarifying, 40 41 shared decision-making, 35 38 Affordable Care Act, 36 barriers and motivators, 37 evidence for, 36 37 European Society of Cardiology, guidelines on perioperative cardiovascular evaluation before noncardiac surgery, 59 70 Exercise testing, in preoperative evaluation of patients with cardiac disease before noncardiac surgery, 63 64 to assess risk of postoperative pulmonary complications, 82 Exercise training, before a physiologic challenge, 147 148 preoperative programs for, 148 150 6-minute walk test, 149 150 F Fairness, DNR orders in the operating room, 39 40 Fetal effects, effects of anesthesia and surgery during pregnancy, 215 218 Folate deficiency, treatment of preoperative anemia due to, 136 Frailty, preoperative assessment of, in geriatric patients, 178 Functional assessment, preoperative, in geriatric patients, 173 G Gastrointestinal assessment, preoperative, for non-operating room anesthesia, 234 Gastroparesis, in preoperative evaluation of patients with diabetes mellitus, 158 159 Genetic testing, preoperative, 53 Geriatric patients, preoperative assessment of, 171 184 cardiac evaluation, 172 173 comprehensive geriatric assessment, 178 179 decision for surgery, 179 181 delirium, 174 176 frailty, 178 functional assessment, 173 174 medication management, 176 177 neurocognitive and behavioral assessment, 172
246 Index Geriatric (continued) nutrition, 177 178 pulmonary evaluation, 173 Glanzmann thrombasthenia, perioperative management of, 114 Glucose testing, preoperative, 51 52 Glucose-6-phosphate dehydrogenase deficiency, perioperative management of, 116 Glycated hemoglobin, preoperative, 51 52 Glycemic control, perioperative, in patients with diabetes mellitus, 161, 164 165 H Health status, general, and risk of postoperative pulmonary complications, 76 Heart failure, and risk of postoperative pulmonary complications, 77 Hematocrit, preoperative, 52 Hematologic disorders, perioperative approach to, 101 126 coagulation disorders, 101 117 activated partial thromboplastin time abnormality, 104 105 bleeding risk assessment, 102 bleeding time, 105 chronic kidney disease, 114 115 coagulation pathway assessment, 102 104 glucose-6-phosphate dehydrogenase deficiency, 116 hemophilia and von Willebrand disease, 105 108 platelet count assessment, 108 110 platelet dysfunction, 114 sickle cell anemia, 115 special hematologic considerations, 115 117 thrombocytopenia, 110 113 thrombocytosis, 116 117 patients on chronic anticoagulant therapy, 119 123 target-specific oral anticoagulants, 121 123 venous thromboembolism, in patients undergoing hip or knee replacement, 119 methods for prevention, 117 118 Hemoglobin A1c, in preoperative evaluation of patients with diabetes mellitus, 156 Hemophilia, perioperative approach to, 105 107 Heparin-induced thrombocytopenia, perioperative management of, 112, 113 Hyperglycemia, postoperative, avoidance in surgical patients, 146 Hypoglossal nerve stimulators, perioperative management of patients with, 195 I Immune thrombocytopenia, primary, perioperative management of, 111 112 Immunonutrition, in surgical patients, 147 Implantable devices, assessment and perioperative management, 185 199 cardiovascular implantable electronic devices, 186 190 intraoperative management, 188 189 possible sources of electromagnetic interference and its consequences, 187 188 preoperative assessment, 188 neurostimulators, 191 195 deep brain stimulators, 193 hypoglossal nerve stimulators, 195
Index 247 phrenic nerve and diaphragmatic stimulators, 195 spinal cord stimulators, 193 194 vagal nerve stimulators, 195 other implantable devices, 196 ventricular assist devices, 190 191 specific hemodynamic considerations, 191 Insulin pumps, in preoperative evaluation of patients with diabetes mellitus, 165 166 Insulin resistance, avoidance of, in surgical patients, 146 Interstitial lung disease, and risk of postoperative pulmonary complications, 75 76 Iron deficiency anemia, preoperative, treatment of, 136 J Justice, DNR orders in the operating room, 39 40 K Kidney disease, chronic, and risk of postoperative pulmonary complications, 78 perioperative acute injury, stratification and risk reduction, 89 99 L Laboratory testing, preoperative, coagulation studies, 52 53 electrocardiogram, 46 48 genetic testing, 53 hematocrit, 52 highly sensitive troponin, 48 natriuretic peptides, 48 49 pregnancy testing, 50 51 renal function testing, 49 50 role of age, 46 test grid studies, 45 46 testing for blood glucose and glycated hemoglobin, 51 52 urine analysis, 50 Laparoscopic surgery, vs open, and risk of postoperative pulmonary complications, 79 80 M Magnetic resonance imaging (MRI), effects on cardiovascular implantable electronic devices, 188 Magnets, effects on cardiovascular implantable electronic devices, 188 Malnutrition, detection of before surgery, 144 Marijuana use, preoperative evaluation and perioperative considerations, 205 206 Maternal effects, effects of anesthesia and surgery during pregnancy, 214 215 Medical consultations. See Consultations, preoperative. Medical ethics. See Ethical issues. Medication management, perioperative, in geriatric patients, 176 177 perioperative, in patients with diabetes mellitus, 160, 162 163 periprocedural, for non-operating room anesthesia, 237
248 Index Myocardial infarction, preoperative testing before noncardiac surgery in patients who have had, 61 N Natriuretic peptides, in preoperative testing, 48 49 Neurocognitive assessment, preoperative, in geriatric patients, 172 Neurologic impairment, and risk of postoperative pulmonary complications, 78 Neuromuscular blockade, and risk of postoperative pulmonary complications, 79 Neurostimulators, assessment and perioperative management of patients with, 191 195 deep brain stimulators, 193 hypoglossal nerve stimulators, 195 phrenic nerve and diaphragmatic stimulators, 195 spinal cord stimulators, 193 194 vagal nerve stimulators, 195 Non-operating room anesthesia, 223 240 adding value of anesthesiologists, 225 226 anesthesia vs procedural sedation, 226 229 assessment of environment for, 229 230 challenges of, 224 225 diagnostic testing, 235 237 future directions, 237 patient assessment for, cardiovascular, 231 233 gastrointestinal, 234 obstetric, 234 235 pulmonary, 233 234 renal, 234 preprocedural medication management, 237 procedural assessment, 235 quality assurance, 225 Nonmaleficence, DNR orders in the operating room, 39 Nutrition, preoperative, 143 153 anemia due to nutritional deficiency, 136 avoiding insulin resistance and postoperative hyperglycemia, 146 detecting malnutrition before surgery, 144 145 immunonutrition, 147 nutrition assessment and optimization, 144 prehabilitation, 147 150 role of total parenteral nutrition, 145 146 screening in geriatric patients, 177 178 Nutritional status, and risk of postoperative pulmonary complications, 78 O Obesity, and risk of postoperative pulmonary complications, 77 Obstetric patients, preoperative assessment of, for non-operating room anesthesia, 234 235 Obstructive sleep apnea, and risk of postoperative pulmonary complications, 77 Operating room, do not resuscitate (DNR) orders in, 38 41 reconciliation of these two perspectives, 38 40 autonomy, 39
Index 249 beneficence, 39 biomedical ethical principles, 39 justice and fairness, 39 40 nonmaleficence, 39 responsibility for discussing and clarifying, 40 41 Opioid addiction, postoperative, 209 preoperative evaluation and perioperative considerations in patients with, 205 206 P Patient blood management, for surgery, 138 Phrenic nerve stimulators, perioperative management of patients with, 195 Platelet count, preoperative assessment of, 108 110 Platelet dysfunction, perioperative management of, 114 inherited disorders of, 114 testing, 114 Postoperative pulmonary complications. See Pulmonary risk. Pregnancy, 213 222 effects of anesthesia and surgery, 214 218 fetal, 215 218 maternal, 214 215 effects of anesthesia and surgery during, 214 218 non-obstetric surgeries or procedures requiring anesthesia during, 218 physiologic changes during, 213 214 preoperative testing for, 50 51, 220 recommendations for, 218 220 intraoperative, 220 postoperative, 220 preoperative, 218 219 coordination of care and fetal well-being, 218 219 NPO guidelines and aspiration pneumonia, 219 Pregnancy testing, preoperative, 50 51, 220 Prehabilitation, preoperative, 143 153 exercise programs, 148 150 6-minute walk test, 149 150 exercise training before a physiologic challenge, 147 148 physical activity and health outcomes, 147 Preoperative evaluation, 1 240 consultations, 17 33 coordination of, 24 25 cost of, 23 24 current use of, 19 23 medicolegal aspects, 25 26 outcomes and, 26 28 purpose of, 18 19 recommendations, 28 29 ethical issues, 35 42 do not resuscitate in the operating room, 38 41 shared decision-making, 35 38 evaluation of major organ systems, 59 70, 71 88, 89 99, 101 126 anticoagulants and hematologic disorders, 101 126
250 Index Preoperative (continued) patients with cardiac disease undergoing noncardiac surgery, 59 70 perioperative acute kidney injury, 89 99 pulmonary risk estimation, 71 88 innovative treatment and preparation programs, 127 141, 143 153 for anemia, 127 141 definition, 127 epidemiology, 128 evaluation for, 131 135 in patients with sickle cell disease, 137 138 patient blood management, 138 perioperative blood transfusions for, and postoperative outcomes, 130 131 preoperative optimization of patients and anemia evaluation, 128 130 treatment of, 136 137 nutrition and prehabilitation, 143 153 avoiding insulin resistance and postoperative hyperglycemia, 146 detecting malnutrition before surgery, 144 145 immunonutrition, 147 nutrition assessment and optimization, 144 prehabilitation, 147 150 role of total parenteral nutrition, 145 146 laboratory testing, 43 58 coagulation studies, 52 53 electrocardiogram, 46 48 genetic testing, 53 hematocrit, 52 highly sensitive troponin, 48 natriuretic peptides, 48 49 pregnancy testing, 50 51 renal function testing, 49 50 role of age, 46 test grid studies, 45 46 testing for blood glucose and glycated hemoglobin, 51 52 urine analysis, 50 preoperative clinics, 1 15 benefits and outcomes, 4 5 developing programs for, 5 6 history and background, 2 4 identifying resources, 9 12 performance management and quality improvement, 12 visit volume and space, 10 12 workforce, 9 10 scope of, 6 7 specific services delivered, 8 9 algorithms, 9 communication, 9 in-person clinic visits, 9 phone calls, 9 triage, 8 9 tactical and operational plans, 7 8
special considerations, 155 169, 171 184, 185 199, 201 211, 213 222, 223 240 diabetes mellitus, 155 169 autonomic dysfunction, 157 159 classification, 156 157 comorbidities associated with, 159 medication considerations, 160 physical examination considerations for anesthesiologist, 160 166 related complications, impact on perioperative risk, 157 geriatric patients, 171 184 cardiac evaluation, 172 173 comprehensive geriatric assessment, 178 179 decision for surgery, 179 181 delirium, 174 176 frailty, 178 functional assessment, 173 174 medication management, 176 177 neurocognitive and behavioral assessment, 172 nutrition, 177 178 pulmonary evaluation, 173 implantable devices, 185 199 cardiovascular implantable electronic devices, 186 190 neurostimulators, 191 195 other implantable devices, 196 ventricular assist devices, 190 191 non-operating room anesthesia, adding value of anesthesiologists, 225 226 anesthesia vs procedural sedation, 226 229 assessment of environment for, 229 230 challenges of, 224 225 future directions, 237 patient assessment for, 231 237 quality assurance, 225 pregnancy, 213 222 fetal effects of anesthesia and surgery, 215 218 maternal effects of anesthesia and surgery, 214 215 non-obstetric surgeries or procedures requiring anesthesia during, 218 physiologic changes during, 213 214 preoperative testing for, 220 recommendations for, 218 220 substance use disorder, 201 211 impact and associated illnesses, 202 incidence, 201 202 perioperative considerations, 202 postoperative risk of new or relapsed, 209 screening for, 202 203 specific abused substances, 203 209 Primary immune thrombocytopenia, perioperative management of, 111 112 Prothrombin time abnormality, perioperative approach to, 102 104, 105 Pulmonary assessment, preoperative, for non-operating room anesthesia, 233 234 Pulmonary function test, to assess risk of postoperative pulmonary complications, 80 81 Pulmonary hypertension, and risk of postoperative pulmonary complications, 77 Index 251
252 Index Pulmonary risk, preoperative evaluation of, 71 88 definition of postoperative pulmonary complications, 72 74 in geriatric patients, 173, 174 nonpulmonary risk factors, 76 78 age, 76 chronic kidney disease, 78 dependent functional status, 78 general health status, 76 heart failure, 77 neurologic impairment, 78 nutritional status, 78 obesity, 77 obstructive sleep apnea, 77 pulmonary hypertension, 77 perioperative strategies to decrease postoperative complications, 84 85 physical examination, 80 procedure-related risk factors, 78 80 duration of surgery, 78 79 emergency surgery, 80 neuromuscular blockade, 79 open versus laparoscopic surgery, 79 80 surgical site, 78 type of anesthesia and analgesia, 79 pulmonary pathology in perioperative period, 72 pulmonary risk factors, 74 76 asthma, 75 chronic obstructive pulmonary disease, 74 75 interstitial lung disease, 75 76 smoking, 74 upper respiratory tract infection, 76 risk scores, 82 84 tests for, 80 82 arterial blood gas, 81 82 chest radiograph, 81 echocardiography, 82 exercise testing, 82 pulmonary function test, 80 81 Q Quality assurance, with non-operating room anesthesia, 225 R Radiographs, chest, to assess risk of postoperative pulmonary complications, 81 Red cell transfusion, for treatment of preoperative anemia due to, 137 allogeneic, 137 autologous, 137 Referrals, for preoperative medical consultation, 17 33 Renal assessment, preoperative, for non-operating room anesthesia, 234 Renal function testing, preoperative, 49 50
Index 253 Renal protection strategies, for perioperative acute kidney injury, 94 96 Risk factors, for postoperative pulmonary complications, nonpulmonary, 76 78 age, 76 chronic kidney disease, 78 dependent functional status, 78 general health status, 76 heart failure, 77 neurologic impairment, 78 nutritional status, 78 obesity, 77 obstructive sleep apnea, 77 pulmonary hypertension, 77 procedure-related, 78 80 duration of surgery, 78 79 emergency surgery, 80 neuromuscular blockade, 79 open versus laparoscopic surgery, 79 80 surgical site, 78 type of anesthesia and analgesia, 79 pulmonary, 74 76 asthma, 75 chronic obstructive pulmonary disease, 74 75 interstitial lung disease, 75 76 smoking, 74 upper respiratory tract infection, 76 Risk scores, for probability of postoperative pulmonary complications, 82 84 Risk stratification, of perioperative acute kidney injury, 90 94 S Screening, for substance abuse, preoperative, 202 203 Sedation, anesthesia vs, in non-operating room procedures, 226 229 Shared decision-making, as a perioperative ethical issue, 35 38 Affordable Care Act, 36 barriers and motivators, 37 evidence for, 36 37 Sickle cell anemia, perioperative management of, 115 Sickle cell disease, preoperative anemia in patients with, 137 138 Six-minute walk test, preoperative testing with, 149 150 Sleep apnea, and risk of postoperative pulmonary complications, 77 Smoking, and risk of postoperative pulmonary complications, 74 Spinal cord stimulators, perioperative management of patients with, 193 194 Stimulant abuse, preoperative evaluation and perioperative considerations, 205 206 Substance use disorder, perioperative considerations, 201 211 impact and associated illnesses, 202 incidence, 201 202 perioperative considerations, 202 postoperative risk of new or relapsed, 209 alcohol and food addiction transfer, 209 opioid addiction, 209 screening for, 202 203
254 Index Substance (continued) specific abused substances, alcohol, 203 205 cannabinoids, 205 206 cocaine and other stimulants, 208 hallucinogens and psychedelics, 208 opioids and heroin, 206 208 Surgery, decision for, in geriatric patients, 179 181 patient blood management, 138 preoperative clinics, 1 15 procedure-related risk factors for postoperative pulmonary complications, 78 80 duration of, 78 79 emergency, 80 neuromuscular blockade, 79 open versus laparoscopic, 79 80 surgical site, 78 type of anesthesia and analgesia, 79 T Target-specific oral anticoagulants, perioperative management of patients on, 121 123 Test grid studies, in preoperative laboratory testing, 45 46 Thrombocytopenia, preoperative assessment of, 110 114 disseminated intravascular coagulation, 112 drug-induced, 112 heparin-induced, 112, 113 primary immune, 111 112 Thrombocytosis, perioperative management of, 116 117 Total parenteral nutrition, role of, 145 146 Transfusion. See Blood transfusion. Troponin, highly sensitive, in preoperative testing, 48 U Upper respiratory tract infection, and risk of postoperative pulmonary complications, 76 Urine analysis, preoperative, 50 V Vagal nerve stimulators, perioperative management of patients with, 195 Venous thromboembolism, perioperative risk stratification and prevention, 117 119 Ventricular assist devices, perioperative management of patients with, 191 Vitamin B 12 deficiency, treatment of preoperative anemia due to, 136 von Willebrand disease, perioperative approach to, 107 108