Is health care
a risky business?. 9
Who is not
suitable for elective anaesthesia?. 9
What harms
patients postoperatively. 9
PACE =
Perioperative Adverse Cardiac Event 10
Major
procedure (highly invasive surgery) 10
Minor surgery
(moderately invasive surgery) 10
Minimal
procedure (minimally invasive surgery) 10
Get the side
and site of the surgery correct 11
Box Hill
Hospital's policy on consent 11
The minimum
the patient needs to know. 11
Laparoscopic
cholecystectomy. 14
Gastric
banding - laparoscopic. 14
Abdominoplasty
(apronectomy) 15
Abdominal
aortic aneurysms (AAA) 16
Infra-inguinal
vascular surgery. 17
Total
cystectomy ± ileal conduit 18
Extracorporeal
shock wave lithotripsy (ESWL) 18
TURP = transurethal resection of the
prostate. 18
Total knee
replacement (TKR) 19
Routine
preoperative investigations. 20
About magnetic
resonance imaging. 22
Don't order
routine blood sugars. 22
Don't order
routine clotting studies. 22
Don’t order
routine troponin T levels. 22
VOMIT =
victims of medical investigative technology. 22
Patients with
ischaemic heart disease + 48. 23
Patients with
heart failure need + 57. 23
Recent
bleeding, anaemia or bruising disorder + 37. 23
Who needs
respiratory function tests + 70. 23
What to do
with smokers + 67. 24
What
medication to take on the day of surgery. 24
How to
instruct patients about their medication. 24
Cautions with
other medication. 24
What are the
land-mines with medication?. 25
What to do about
patients on chemotherapeutic agents. 25
Careless
prescribing fills graveyards. 25
Preadmission
an opportunity to check drug interactions. 26
How long will
I be in hospital?. 29
Five fears
patients have about anaesthetics. 29
What are the
risks of general anaesthesia?. 29
What are the
risks of spinal anaesthesia?. 30
What are the
risks of epidural anaesthesia?. 30
About back
pain after epidurals and spinals. 30
What are the
risks of brachial plexus block?. 30
Things that
worry patients. 34
How long will
it take to get over my operation?. 34
Do
anaesthetics affect my brain?. 35
When can I
start driving again?. 35
How to use a
pulse oximeter to test cardio-respiratory function. 37
Hypercoagulability
testing in superclotters. 38
What to do
about anticoagulants. 39
Dipyridamole ±
aspirin (Asasantin) 40
NSAIDs and
COX-2 inhibitors + 21. 40
How to reverse
warfarin to achieve a normal INR. 42
How to reverse
warfarin in a hurry. 43
LMWH and
epidural or spinal anaesthesia. 43
Postoperative
anticoagulation. 44
When to
restart warfarin postoperatively. 44
Graduated
compression stockings (GCS) 44
Contraindications
to prophylaxis. 44
What do I
check with haemostatic disorders?. 45
Don’t get
tangled in red tape. 46
The top 10
patients likely to need a blood transfusion. 47
What are the
signs of anaemia?. 47
What are the
common causes of anaemia?. 47
About
pre-donated autologous blood (PDAB) 47
Who cannot
pre-donate their own blood?. 47
Special blood
preparations. 48
Some patients
bleed to death. 49
How much blood
to cross-match for elective surgery. 50
Coronary
artery disease + 48. 51
Supraventricular
arrhythmias. 51
Who do I refer
the patient to?. 52
How to PASS the evaluation. 52
2. Ischaemic heart disease. 56
What are the
risks of perioperative infarction following a prior MI 60
About coronary
artery bypass graft (CABG) 61
Postoperative
management of IHD. 63
What happens
if you don’t fix cardiac failure. 69
How to
recognize heart failure. 69
Markers for
cardiac failure. 70
What causes
breathlessness?. 70
What to do
about heart failure preoperatively. 70
What to do
about ankle oedema. 71
Review the
patient’s therapy. 71
How serious is
the cardiac failure. 71
Functional
classification of cardiac failure. 71
Echocardiograph
is normal, but the patient is still poorly?. 72
How to assess
severity of VHD. 73
What to do
about symptomatic valvular heart disease. 73
What are the
types of prosthetic valves?. 74
How to manage
patients with prosthetic heart valves. 74
Mitral valve
prosthesis causes extra problems. 74
What are the
troublesome diseases. 79