By Steven L. Cohn
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Extra info for Preoperative medical consultation
Adverse outcome ¼ wound infection. W. S. W. S. Macpherson / Med Clin N Am 87 (2003) 7–40 ciﬁc ST segment changes. Bundle branch block, another common incidental ﬁnding, did not increase the risk of postoperative cardiac complications in a recent cohort analysis of 455 patients with this ﬁnding . 6% (Table 11). This is substantially higher than the yield for abnormal tests among other commonly performed preoperative tests. Many of these abnormalities are not clinically signiﬁcant, however, and do not predict postoperative cardiac complications.
3 with pre-existing pulmonary disease undergoing major surgery . Charpak et al developed a selective protocol for ordering preoperative chest radiographs using similar criteria . Their protocol recommended preoperative chest radiographs for patients with lung disease, cardiovascular disease, cancer, emergent surgery, current smoking history in patients >50 years of age, immune suppression, or a lack of a prior examination in immigrants. 5%) unindicated radiographs impacted on patient management.
The newer nonsteroidal anti-inﬂammatory drugs (NSAIDs), the COX-2 inhibitors, have little or no eﬀect on platelets. All NSAIDs can have adverse eﬀects on renal function; this eﬀect may be accentuated in the perioperative period, which is another reason for holding these drugs perioperatively. The COX-2 inhibitors should be held at least 2–3 days before surgery because of the potential renal issues . , New York, NY) and ticlopidine (TiclidÒ, Parcor) are structurally similar agents that irreversibly inhibit platelet aggregation, probably by blockade of adenodiphosphate (ADP) binding to its receptor on the surface of platelets .