Perioperative Evaluation: Dr. Deasiana Paksi Moeda SP.B, Finacs 24 Agustus 2021
Perioperative Evaluation: Dr. Deasiana Paksi Moeda SP.B, Finacs 24 Agustus 2021
Perioperative Evaluation: Dr. Deasiana Paksi Moeda SP.B, Finacs 24 Agustus 2021
EVALUATION
Dr. Deasiana Paksi Moeda Sp.B, FInaCs
24 Agustus 2021
Hippocrates (460-335 BC)
• Primum, non nocere
• First, do no harm
Triage
Diagnosis
Masalah pra-bedah
Masalah intra-bedah
Masalah pasca-bedah
Follow up
Preoperative Evaluation
• The purpose of a preoperative evaluation is not to “clear” patients for
elective surgery, but rather to evaluate and, if necessary, implement
measures to prepare higher risk patients for surgery.
• Pre-operative outpatient medical evaluation can decrease the length
of hospital stay as well as minimize postponed or cancelled surgeries.
Preoperative History and Physical
Examination
• The history : the condition for which the surgery is planned, any past surgical procedures,
and the patient's experience with anesthesia.
• In children: birth history, prematurity at birth, perinatal complications and congenital
chromosomal or anatomic malformations, and history of recent infections
• Chronic medical conditions, particularly of the heart and lungs.
• Medications should be noted. Drug dosages may need to be adjusted in the perioperative
period. Aspirin and non-steroidal anti-inflammatory drugs should be discontinued one
week before surgery to avoid excessive bleeding.
• Immunization status can be documented, and vaccines can be updated if necessary.
• The patient should be asked about smoking history and alcohol and drug use.
• The physician should review the patient's social support and need for assistance after
hospital discharge.
• Patients with cardiopulmonary disease may warrant a second
examination just before hospitalization.
• Patients who have pulmonary disease or who will undergo abdominal
or thoracic surgery can be given instructions for performing incentive
spirometry. The patient should also be provided with information
about the expected postoperative course and possible complications.
• Informed consent
Laboratory Assesment
Preoperative laboratory studies : complete blood count, extensive blood chemistry profile, urinalysis,
prothrombin time, partial thromboplastin time, electrocardiogram (ECG) and chest radiographs.
• A hemoglobin measurement is useful in detecting unsuspected anemia and providing a baseline level,
which can be helpful information postoperatively, particularly for surgeries with potential hemorrhagic
complications.
• Renal and liver function studies are not routinely needed but may be indicated for patients who have a
medical condition
• Preoperative glucose determination should be obtained in patients 45 years or older,
• A urine pregnancy test should be considered for women of childbearing age.
• Coagulation times are not routinely indicated, as studies have shown that the yield is very low and that
abnormal results are expected or do not significantly affect
• An ECG is also not routinely indicated in patients 40 years or younger
• Chest radiographs should be obtained on the basis of findings from the medical history or physical
examination.
Cardiac Evaluation
• With the increasing size of the middle-aged and elderly population,
more surgical procedures will be performed in patients who have or
potentially have coronary artery disease.
• Cardiac complications are the most common type of complication
that can threaten the surgical patient's life or prolong the patient's
hospital stay.
Surgery-Related Predictors for Risk of Perioperative Cardiac Complications