Recognition and management of preoperative risk

The major role of the internist in the perioperative period is to identify and quantify a patient's risk for surgery, to minimize this risk, to monito r for problems, and to treat problems as they occur. A careful history and physical examination with only very selective laboratory testing and imagin g is indicated. Cardiac issues predominate. An al,algorithmic approach that uses risk indices and selective interventions is presented. Other common p roblems include pulmonary diseases, diabetes, anemia, and specific concerns in the elderly and those with rheumatologic diseases. This article reviews a practical approach to the evaluation and treatment of these issues as we ll.