Abriana Gaul
Posted Date
Mar 18, 2022, 12:19 PM
It was very intriguing to learn that the purpose of preoperative evaluation prior to an elective surgical procedure is not to clear the patient for the surgery but is rather completed to evaluate if the patient has risks that need measures implemented to prepare them for the procedure (King, 2000). For example if a patient has risk factors that may increase their risk for an peri or post op complication then the team can determine what preventive measures need to take place to reduce the risks. The clearance also evaluates a patient’s ability to heal effectively post op as well. Risk factors that are evaluated during the preop evaluation varies depending on the elective surgery (Dickerson, 2019). All clearances do include a history and physical exam. During clinical I had a patient that was admitted for chest pain. This was a 64 year old woman with pmHx of HTN, HLD, and DM2. She was admitted to an inpatient tele unit for chest pain and coronary syndrome work up. During her work up she was found to have 75% stenosis of her left ICA and 50% stenosis of her right ICA. This was an incidental finding and had nothing to due with her chest pain. The cardiology team discussed with her the option to have the ICA stented to treat the stenosis. We consulted neurology for further assistance and according to their evaluation this procedure would be elective because the patient has had no neurological symptoms or deficits. Asymptomatic carotid stenosis is typically managed with medical therapy to include daily ASA 81mg and high intensity statin. Risks that the patient and team have to consider with this elective procedure include the following: 10% risk of ipsilateral stroke in 5 yrs, 2-3% procedural risk of stroke and then an additional 2-3% 5 yr risk of stroke post procedure and medical mgmt alone has 10% risk of stroke (Raslau, 2020). Areas of concern that would be reviewed for this patient who elected for carotid stent of her asymptomatic left carotid stenosis include cardiac risks such as heart failure or CAD and intracranial vasculature health. Preop work up included cardiology consult and recs, vascular neurology consult and recs, imaging to include TTE, CTA head/neck, carotid ultrasound, and CT head, labs to include Lipid panel, CMP, CBC, BNP, and troponin. The patient elected to have stent placed and had a successful procedure.
References
Casper, D.S., Rihn, J.A. (2020). Preoperative risk stratification: who needs medical consultation? Spine 45(12), 860-861. Doi: 10.1097/BRS.0000000000003437
Dickerson, S.C. (2019). Preoperative guidelines in anesthesia. Otolaryngologic Clinics 52(6), 981-993. Doi: https://doi.org/10.1016/j.otc.2019.08.001
