BJA Advance Access originally published online on April 30, 2004
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British Journal of Anaesthesia, 2004, Vol. 93, No. 1 121-128
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Preoperative optimization of the high-risk surgical patient
Department of Anaesthetics, York Hospital, Wigginton Road, York YO31 8HE, UK.
*Corresponding author. E-mail: rjtwilson@doctors.org.uk
Keywords: complications, postoperative; drug therapy; heart, cardiac output; inotropes; monitoring; surgery, postoperative period
| The first 150 words of the full text of this article appear below. |
After major surgery there is a significant risk of major complications and even death, particularly in the elderly and patients with significant cardiorespiratory disease. In the UK, recent large audits have shown a 30-day mortality rate of 5.6% for elective colorectal cancer surgery,62 19.3% for emergency colorectal surgery,62 7.3% for elective infrarenal aortic aneurysm and aorto-iliac occlusive disease surgery,4 9–15% for oesophagectomy and 13–15% for elective gastrectomy.34
Major surgery generates a strong systemic inflammatory response that in turn leads to an increase in oxygen requirement from an average of 110 ml min–1 m–2 at rest to an average of 170 ml min–1 m–2 in the postoperative period.43 55 This substantial increase in oxygen demand is normally met by increases in cardiac output and tissue oxygen extraction. Most patients can meet the increased oxygen demand by increasing cardiac output and will usually do well after surgery. However, there remains a group who
Why do patients get major complications after major surgery?
Preoperative haemodynamic optimization of high-risk surgical patients
Preoperative optimization of oxygen delivery
Other preoperative haemodynamic optimization strategies
Identifying patients likely to benefit from preoperative optimization of oxygen delivery
Role of fluids and inotropes
Conclusion
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