supraventricular tachycardia, decompensated heart failure, severe
valvular heart disease with stenotic lesions, stent insertion less than
6 weeks before, and severe aortic stenosis with syncope, chest pain
and dyspnea. Pacemakers are OK, but with AICDs, consult a cardiol-
ogist.
• Severe pulmonary hypertension
• Recent stroke. The AHA and a study published in JAMA recom-
mend that these patients wait 6 months before elective surgery.
• Oxygen dependency with multiple comorbidities, or severe short-
ness of breath at rest.
• Psychological or mental inability to understand the situation or the
surgery, such as an Alzheimer's patient.
Cataract surgery, which is exceedingly low risk, is an exception to
the rule. The only conditions that would likely dictate cancellation are
severe claustrophobia or severe comorbidities.
Greater challenges ahead
It's likely that some of the patients scheduled for surgeries at your
facility simply aren't suitable candidates. In an ideal world, we'd spot
these folks during pre-operative evaluations, but inevitably, some slip
through the cracks. Your anesthesia providers are the last line of
defense. As the gatekeepers for patient evaluation, they determine
which patients are outpatient appropriate, and which aren't.
OSM
Mr. Ruspantine (perryr@anesprof.com) is the clinical
compliance manager and HIPAA compliance officer for Anesthesia
PROfessionals in Dartmouth, Mass.
Anesthesia Alert
AA
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