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PREPARATION
Riza Cintyandy
RS. Jantung & Pembuluh
darah Harapan Kita Jakarta
PREOPERATIVE EVALUATION
Aim :
To reduce the risk associated with surgery &
anesthesia
To increase the quality of perioperative care
To restore the patient to the desired level
of function
To obtain the patients inform consent
waktu pelaksanaan
penyulit anestesi
dll
PHYSICAL STATUS
P1. A normal healthy patient
P2. A patient with mild systemic disease
P3. A patient with severe systemic disease
P4. A patient with severe systemic disease that is a
constant threat to life
P5. A moribund patient who is not expected to survive
without the operation
P6. A declared brain-dead patient whose organs are being
removed for donor purposes
American Society of Anesthesiologists
Pemeriksaan
Airway
GCS
PCS
Eye
opening
Spontaneous
To verbal stimuli
To pain
None
4
3
2
1
Ditto
Verbal
Oriented
Confused
Inappropriate words
Non specific sounds
None
5
4
3
2
1
Oriented
Words
Vocal sounds
Cries
None
Motor
Follows commands
Localises pain
Withdraws in response to
pain
Flexion in response to pain
Extension in response to pain
None
6
5
4
3
2
1
Ditto
5
4
3
2
1
TRAUMA SCORE
Trauma Score
16
13
10
7
4
1
% Survival
99
93
60
15
2
0
Mild
Moderate
Pain threshold
Pain tolerance
Severe
10
Mild
paracetamol
or/+
NSAID
adjuvant
analgesic
10
Moderate
Severe
NSAID
weak opioid
adjuvant
analgesic
Strong opioid
NSAID
adjuvant
analgesic
FASTING GUIDELINES
Adult
Food : 6 hour
Severe aritmia
PRINSIP
clinical predictors
Intermediate
clinical predictors
Minor
clinical predictors
Advanced age
Abnormal ECG
Rhythm other than sinus
Low functional capacity
History of stroke
Uncontrolled systemic hypertension
TYPES OF SURGERY
High
risk
Intermediate
risk
Carotid endarterectomy
Head and neck surgery
Intraperitoneal and intrathoracic surgery
Orthopaedic and prostate surgery
Low
risk
Endoscopic procedures
Superficial procedures
Cataract surgery
Breast surgery
ACC/AHA GUIDELINES
Yes
Operating room
Vigilant perioperative
and postoperative
management
No
Active
cardiac
conditions
Yes
Consider
Operating Room
No
Low Risk
Surgery
Yes
Proceed with
planned surgery
Yes
Proceed with
planned surgery
No
Asymptomatic and
good functional
capacity
No
Manage based on
clinical risk factors
Yes
Operating room
Vigilant perioperative
and postoperative
management
No
Active
cardiac
conditions
Yes
Consider
Operating Room
No
Low Risk
Surgery
Yes
Proceed with
planned surgery
Yes
Proceed with
planned surgery
No
Asymptomatic and
good functional
capacity
No
Manage based on
clinical risk factors
Functional Capacity
1. Correlates with maximum oxygen
uptake on treadmill testing
2. Demonstrated predictor of future
cardiac events
3. Poor functional capacity may
hide low threshold cardiac
symptoms
4 METs
Greater than
10 METs
STEP 1
Emergency
surgery
STEP 2
No
STEP 3
yes
Favorable result
and no change
in symptoms
Operating
room
Clinical
predictors
Major clinical
predictors
Recurrent
symptoms or
signs?
yes
No
STEP 4
No
yes
Coronary revascularization
within 5 yr
Postoperative risk
stratification and risk
factor management
Operating
room
STEP 5
Consider coronary
angiography
Intermediate clinical
predictors
Minor or no clinical
predictors
Go to step 6
Go to step 7
STEP 6
Clinical predictors
Functional capacity
High surgical
risk
procedure
Surgical risk
STEP 8
Noninvasive
testing
Moderate or
excellent
( > 4 METs)
Poor
(< 4 METs)
Noninvasive
testing
Low Risk
High Risk
Invasive
testing
Consider coronary
angiography
Intermediate
surgical risk
procedure
Operating
room
Low
surgical risk
procedur
Postoperative risk
stratification and
risk factor reduction
STEP 7
Functional capacity
STEP 8
Clinical predictors
Poor
(< 4 METs)
Surgical risk
High surgical
risk
procedure
Noninvasive
testing
Noninvasive
testing
Intermediate
or low
surgical risk
procedure
Low Risk
High Risk
Invasive
testing
Moderate or
excellent
( > 4 METs)
Consider coronary
angiography
Operating
room
Postoperative risk
stratification and
risk factor reduction
SUGGESTION
1.
2.
3.
ANESTHETIC GOALS
1.
2.
3.
4.
5.
6.
HYPERTENSIVE
HYPERTENSIVE
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