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PREOPERATIVE ASSESSMENT OF THE GERIATRIC PATIENT Cheryl Hinners M.D.
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CASE –MR. PREOP IS A 75YO WM WITH THE PMH OF COPD(NO MEDS, CONTINUES TO SMOKE), DM-2, OA, HTN, AND CAD WITH AN MI 5 YRS AGO. HE HAS BEEN DIAGNOSED WITH PROSTATE CA AND AN OPEN PROSTATECTOMY IS PLANNED. –LIVES INDEPENDENTLY, SWING DANCES 2X /WEEK. MEDS; ASA, IBPROFEN, NPH BID, FELODIPINE
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MORE THAN 50% OF OLDER AMERICANS WILL HAVE A SURGICAL PROCEDURE AFTER AGE 65 ASA CLASSIFICATIONS DECREASED SURGICAL MORTALITY
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PREOP ASSESSMENT IDENTIFY INCREASE RISK FOR COMPLICATIONS MAKE RECOMMENDATIONS –COMORBID CONDITIONS –PHARMACOLOGIC TX –FUNCTIONAL/PSYCHOLOGIC STATES
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ASSESSING RISK OF CARDIAC COMPLICATIONS MOST COMMON AND SERIOUS STRONGEST PREDICTORS OF ADVERSE CARDIAC OUTCOMES –RECENT MI –UNCOMPENSATED CHF –USA –ARRYTHMIAS
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PRACTICE GUIDELINES MAJOR CLINICAL PREDICTORS USA, CHF, ARRYTHMIAS, SEVERE VALVULAR DZ INTERMEDIATE MILD ANGINA, PRIOR MI, COMPENSATED CHF, DM
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MINOR CLINICAL PREDICTORS –ADVANCED AGE –ABNORMAL EKG –ABNORMAL RHYTHM –LOW FUNCTIONAL CAPACITY(METS) –H/O STROKE –UNCONTROLLED HTN
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PROCEDURE RISK HIGH –EMERGENT –MAJOR VESSEL PROCEDURE –PVD PROCEDURE –PROLONGED PROCEDURE
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INTERMEDIATE RISK –CAROTID ENDARTECTOMY –HEAD AND NECK PROCEDURES –INTRAPERITONEAL/INTRATHORACIC –ORTHOPEDIC –PROSTATE
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LOW RISK PROCEDURES –BREAST –CATARACT –ENDOSCOPIC
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MANAGEMENT OF SELECTED PROBLEMS HTN –DIASTOLIC BP >110 OR MAJOR FLUCTUATIONS IN BP –ELEVATED BP REVIEW MEDS, CONSIDER AGE-RELATED CHANGES, VOLUME STATUS, PAIN, FULL BLADDER.
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CHF –SIGNIFICANT RF FOR CARDIAC COMPLICATIONS –TX OF SYSTOLIC DYSFUNCTION –MANAGEMENT INTRAOP
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PULMONARY DISEASE –POSTOP MORBIDITY IN 40% ELDERLY FROM RESPIRATORY PROBLEMS –AGE-RELATED CHANGES –ANESTHESIA –SURGICAL PROCEDURE –POSTOP PAIN MEDS
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****PREOP FUNCTIONAL LEVEL IS A RELIABLE PREDICTOR OF PULMONARY COMPLICATIONS******
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INTERVENTIONS –SMOKING CESSATION –COPD CONSIDERATIONS
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DIABETES –MEDICATION CONSIDERATIONS
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THROMBOEMBOLIC DZ –OCCUR IN 20-30% OF PATIENTS UNDERGOING GENERAL SURGERY –HIGHER INCIDENCE, >40% HIP/KNEE GYN CA/ OPEN PROSTATECTOMY NEUROSURG
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NEUROPSYCHIATRIC DISORDERS –DEMENTIA –DELIRIUM –DEPRESSION EXACERBATION –ALCOHOLISM
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POSTOP PAIN PAIN SCALE MEDICATIONS LAXATIVES
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PREDICTORS OF POOR OUTCOME ADVANCED AGE POOR FUNCTIONAL STATUS IMPAIRED COGNITION LIMITED SOCIAL SUPPORT
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IATROGENIC ILLNESS DVT DOSING DRUGS DRUG-DRUG INTERATIONS PRESSURE ULCERS DEHYDRATION
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