Dental Preoperative Risk Assessment; Preoperative Evaluation.
-H&P performed.
–Antibiotic Prophylaxis before the dental procedure is Not indicated in this patient.
-The incidence of perioperative cardiovascular events varies according to the patient risk profile, patient’s functional capacity, and risk of the proposed surgery.
1) Active Cardiac Conditions that are Contraindications to Elective Surgery: None present.
2) Surgery-Specific Cardiac Risk): Dental procedures are low-risk procedures.
3) Cardiac risk by patient profile (RCRI): RCRI risk factors include: ______________. This corresponds to a _____ percent risk of major perioperative cardiovascular events (such as MI, stroke, CHF, or malignant arrhythmia, etc).
4) Functional Capacity(expressed in METS) = ______ METS. The patient reports being able to _____________(describe activities).
The procedure, alternative treatments, risks, and benefits were explained to the patient. Risk of MACE in the perioperative period explained to the patient.
This patient is at ______ risk for a ___________ risk procedure.
This evaluation will be transmitted to the surgery and anesthesia teams.
—END—
Key Points
- Patients with active cardiovascular signs or symptoms should get an ECG and be worked up just like it would be done without the surgery.
- Cardiac Evaluation Algorithm(check this out)
PRE: The pre-operative Recommendations Engine
Perioperative management of patients receiving anticoagulants
Preoperative Evaluation, AAFP
Preoperative Examination, FPNotebook.com
Preoperative Evaluation Form, AAFP
Anesthesia Preoperative Form, UCLA
A 60-year-old male is scheduled for coronary revascularization. Which one of the following would reduce his cardiovascular risk the most when given perioperatively?
A.Beta-Blockers
B.Calcium channel blockers
C.Statins
D.Aspirin
E.Warfarin (Coumadin)
Statins are the drugs of choice to reduce perioperative cardiovascular risks (level of evidence 1). In addition to lowering cholesterol, they also reduce vascular inflammation, improve endothelial function, and stabilize atherosclerotic plaques. For the most protection, statins should be started 4 weeks prior to the procedure and continued after surgery (SOR A). Beta-Blockers and aspirin are beneficial but less so than statins.
Ref: Holt NF: Perioperative cardiac risk reduction. Am Fam Physician 2012;85(3):239-246.
References
Am Fam Physician. 2013 Mar 15;87(6):414-418.
Am Fam Physician. 2000 Jul 15;62(2):387-396.
AFP 2007;75:656, http://www.aafp.org/afp/2007/0301/p656.pdf
Am Fam Physician. 2002 Nov 15;66(10):1889-1897. http://www.aafp.org/afp/2002/1115/p1889.html
Pocket Primary Care
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/perioperative-evaluation/ (Last Accessed 4/24/2017)
Read this article: http://www.aafp.org/afp/2013/0315/p414.html