Perioperative Medicine Steven L. Cohn (Editor) Perioperative Medicine Editor Steven L. Cohn Director – Medical Consultation Service Kings County Hospital Center Clinical Professor of Medicine SUNY Downstate Brooklyn, NY ISBN 978-0-85729-497-5 e-ISBN 978-0-85729-498-2 DOI 10.1007/978-0-85729-498-2 Springer London Dordrecht Heidelberg New York British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Control Number: 2011931531 © Springer-Verlag London Limited 2011 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permit- ted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licenses issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc., in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Cover design: eStudioCalamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface Preoperative risk assessment and perioperative management are important aspects of clinical practice in internal medicine. Whereas surgeons and anesthesiologists spend most of their time caring for patients in the perioperative period, many primary-care physicians and hospitalists may feel inadequately trained or uncomfortable in this setting. The goal of this book is to provide a streamlined approach to the medical aspects of perioperative care, limiting content to make it an easily readable and clinically useful guide. It is intended for use by hospitalists, general internists and specialists, anesthesiolo- gists, surgeons, and residents in training who are involved in the care of patients before and after surgery. The book is divided into four parts. The first part addresses general aspects of periop- erative care, preoperative testing, medication management, and prophylaxis (surgical site infection, venous thromboembolism, endocarditis). The second part highlights aspects specific to various types of surgery, including patient- and surgery-specific risk factors and procedural complications. The third part reviews preoperative evaluation and periopera- tive management of coexisting medical conditions that affect surgical risk. The last part covers evaluation and management of some of the more frequently encountered postopera- tive complications. Because medicine is a constantly changing field, new information may affect some of the recommendations in this book. The information contained in this book is based on what the authors felt was the best available evidence at the time. Additionally, errors, inac- curacies, and omissions may inadvertently occur despite the care that has been taken to avoid them. The reader is advised to use sound clinical judgment and to confirm all doses of medications before prescribing them. I hope that you will find this information useful in your clinical practice and hope that it will lead to improved perioperative patient care. Steven L. Cohn, M.D., FACP v Acknowledgment I would like to thank the authors, most of whom are practicing internists, hospitalists, or anesthesiologists and members of the Society of General Internal Medicine (SGIM) Perioperative Medical Consultation Interest Group (www.sgim.org) or the Society for Perioperative Assessment and Quality Improvement (www.spaqi.org), who have contrib- uted chapters for this book. I would also like to acknowledge my wife, Deborah, children, Alison and Jeffrey, and mother, Lynn, for their love, encouragement, and support in general and specifically during this project. Steven L. Cohn, M.D., FACP vii Contents Part I Preoperative Evaluation 1 Role of the Medical Consultant ........................................................................... 3 Steven L. Cohn 2 Preoperative Testing ............................................................................................. 13 L. Reuven Pasternak 3 Perioperative Medication Management .............................................................. 23 Steven L. Cohn 4 Perioperative Management of Anticoagulation ................................................. 45 Scott Kaatz and David G. Paje 5 Venous Thromboembolism Prophylaxis ............................................................. 55 Steven L. Cohn 6 Prevention of Infective Endocarditis (Bacterial Endocarditis Prophylaxis) .................................................................. 67 Steven L. Cohn 7 Surgical Site Infection Prophylaxis ..................................................................... 73 Amish Ajit Dangodara 8 Anesthesiology for the Nonanesthesiologist ........................................................ 81 Vivek K. Moitra and Rebecca S. Twersky Part II Surgery-Specific Risks 9 Abdominal Surgery ............................................................................................... 99 Brian Woods 10 Thoracic Surgery .................................................................................................. 107 Vivek K. Moitra ix x Contents 11 Vascular Surgery ................................................................................................... 115 Visala S. Muluk 12 Orthopedic Surgery .............................................................................................. 123 Ronald MacKenzie and Edwin P. Su 13 Neurosurgery ......................................................................................................... 131 Victor Duval 14 Gynecologic Surgery ............................................................................................. 137 Bruce E. Johnson 15 Urologic Surgery ................................................................................................... 145 Bruce E. Johnson 16 Bariatric Surgery .................................................................................................. 151 Brian Harte 17 Ophthalmic Surgery ............................................................................................. 161 Deborah C. Richman 18 Otolaryngologic Procedures ................................................................................. 169 Paul J. Primeaux 19 Electroconvulsive Therapy ................................................................................... 179 Howard S. Smith Part III Preoperative Evaluation and Management of Co-existing Medical Diseases 20 Cardiac Disease ..................................................................................................... 189 Steven L. Cohn 21 Pulmonary Disease ................................................................................................ 211 Steven L. Cohn 22 Endocrine Disease ................................................................................................. 227 Amish Ajit Dangodara and Visala S. Muluk 23 Hematologic Disease ............................................................................................. 261 Shuwei Gao and Sunil K. Sahai 24 Cancer .................................................................................................................. 281 Sunil K. Sahai and Ellen F. Manzullo Contents xi 25 HIV ........................................................................................................................ 295 Richard B. Brooks 26 Chronic Kidney Disease ....................................................................................... 303 Mihaela S. Stefan and Adam C. Schaffer 27 GI Disease .............................................................................................................. 315 Nomi L. Traub and Richard B. Brooks 28 Rheumatic Disease ................................................................................................ 329 Brian F. Mandell 29 Neurological Disease ............................................................................................. 343 Lane K. Jacobs and Benjamin L. Sapers 30 Psychiatric Conditions .......................................................................................... 361 Joleen Elizabeth Fixley and Meghan Collen Tadel 31 Substance Abuse ................................................................................................... 381 Nadene C. Fair and Howard S. Smith 32 The Pregnant Surgical Patient ............................................................................. 395 Beth G. Lewis and Michael P. Carson Part IV Postoperative Complications 33 Postoperative Fever .............................................................................................. 411 Barbara A. Cooper and Nadene C. Fair 34 Postoperative Hypertension/Hypotension .......................................................... 421 Steven L. Cohn and Brian Harte 35 Postoperative Arrhythmias .................................................................................. 431 Barbara Slawski and Kurt Pfeifer 36