| Patients for low risk procedures typically done with sedation: |
- In-person evaluation well before the day of surgery is recommended for patients with any one of the conditions from List 1
|
| Triage guidelines for moderate-high risk procedures: |
- In-person evaluation well before the day of surgery is recommended for patients with any one of the conditions from List 1 or List 2
|
| List 1: |
- Poor historians who do not know their medications or medical history
- Unable to lie flat and still for the duration of the procedure
- Obstructive sleep apnea without treatment
- BMI >40
- Heart failure
- Pacemaker or implantable cardiac defibrillator
- Hospitalization for medical problems within the last two months
- Unable to perform activities of daily living (feeding or dressing oneself)
- Myocardial infarction within the last 60 days
- Coronary stents within the last six months
- Stroke or TIA within the last three months
- Use of anticoagulants if these must be stopped for the procedure
- Oxygen use
- Previous serious problems with anesthesia such as malignant hyperthermia, nerve damage
- Dialysis patient
- Severe liver disease
- Cannot hear, speak, or understand the language of clinicians
- Significant dementia or cognitive impairment
- Pregnancy (unless procedure is a termination)
- Obviously difficult airway or history of same
- Poorly controlled hypertension (SBP >160; DBP >100)
- Poorly controlled seizure disorder
- Pulmonary hypertension
- Significant airway abnormalities (goiter, tumors, tracheostomy)
- Hospitalization within the last two months unless the surgery was planned during the hospitalization
|
| List 2: |
- Age >65 years
- Taking >8 prescription medications
- Heart disease of any type
- Medical condition inhibiting normal daily activity
- Inability to climb one flight of stairs
- Conditions necessitating assistance or monitoring at home within last three months
- Diabetes mellitus
- Chronic pain
- Kidney disease
- Liver disease
- Significant lung disease (use of daily medications)
- Likely to require a blood transfusion
- Patient refusing blood transfusion
- Planned postoperative ICU admission
- Previous transplant
- Significant spine disease (eg, scoliosis or neurologic symptoms)
- Rheumatoid arthritis
- Chemotherapy or radiation therapy within the previous three months
- Active cancer
- Thyroid disease
- Adrenal disease
- Neurologic disease (seizure, paralysis)
- Chronic obstructive lung disease
- Muscular dystrophies
|
