Preoperative evaluation

A history and physical examination, focusing on risk factors for cardiac, p ulmonary and infectious complications, and a determination of a patient's f unctional capacity, are essential to any preoperative evaluation. In additi on, the type of surgery influences the overall perioperative risk and the n eed for further cardiac evaluation. Routine laboratory studies are rarely h elpful except to monitor known disease states. Patients with good functiona l capacity do not require preoperative cardiac stress testing in most surgi cal cases. Unstable angina, myocardial infarction within six weeks and aort ic or peripheral vascular surgery place a patient into a high-risk category :for perioperative cardiac complications. Patients with respiratory disease may benefit from perioperative use of bronchodilators or steroids. Patient s at increased risk of pulmonary complications should receive instruction i n deep-breathing exercises or incentive spirometry. Assessment of nutrition al status should be performed. An albumin level of less than 3.2 mg per dL (32 g per L) suggests an increased risk of complications. Patients deemed a t risk because of compromised nutritional status may benefit from pre- and postoperative nutritional supplementation.