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Abnormal pre-operative findings |
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An abnormal ECG Send a copy of an abnormal ECG to the Department of Anaesthesia for reporting preoperatively, stating patients’ age, cardiac symptoms, current drug treatments and the nature and date of the planned operation.
Arrhythmias Any rhythm, other than sinus rhythm can increase the risks of anaesthesia and surgery. A patient in controlled atrial fibrillation with a ventricular rate of <90 does not need further assessment unless there are other complicating factors. A ventricular rate of >100/min requires slowing preoperatively.
Indications for referral for consideration of preoperative pacing 2nd degree AV block Complete heart block Symptomatic sinus node disease— sinus bradycardia or varying PP interval 1st degree block alone is not a problem
Ischaemic changes on ECG Surgery within 6 months of infarct carries an increased risk, so try to establish when the infarct occurred. Any patient who has ischaemic changes on a resting ECG must be referred for cardiology review preoperatively. Even in the absence of chest pain, such changes may represent silent myocardial ischaemia and patients may benefit from optimisation of medical therapy or further investigation with a view to coronary artery bypass grafting.
The majority of other problems discovered by preoperative investigation can be managed by discussing them with the patient’s GP, e.g. hypertension, or hypokalaemia in a patient taking diuretics. If close to the time of surgery, discuss problems with the anaesthetist concerned.
The decision as to whether or not a patient is fit for anaesthesia lies with the anaesthetist. Other specialties offer valuable advice about specific aspects of patient well-being (cardiology opinion may be sought to investigate a murmur).
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Don’t ignore abnormal findings— act on them! |