For example, blood loss and fluid shifts needing immediate replac

For example, blood loss and fluid shifts needing immediate replacement can quickly induce hemodynamic instability, electrolyte disturbance, oxygen supply and demand imbalances that can lead to acute organ dysfunction such as unstable arrhythmias. This process is commonly misinterpreted by non-anaesthesiologists as an evaluation of fitness

for anaesthesia, assuming the anaesthesia is the most life-threatening process to the patient. On the contrary, when performed carefully with appropriate monitoring and timely interventions, the period of anaesthesia represents a period of relative stability for the patient in the vast majority of time. Rather, preoperative risk assessment evaluates the capacity of the patient to withstand the acute physiological perturbations resulting from the entire operative period that extends well into the recovery phase. The critical element is to estimate whether the patient can meet the increased oxygen demand due to the acute stress response to surgery. Therefore, the assessment tends to focus upon the cardiac and MDV3100 research buy respiratory system as these are critical determinants of oxygen Angiogenesis inhibitor supply to tissues. Another point of focus of the examination is conditions affecting the level of consciousness, whether it involves the central nervous system or secondary to metabolic disturbances. Acute delirium

is associated with high perioperative morbidity and mortality. Delayed emergence from anaesthesia may occur in Org 27569 patients suffering from preoperative delirium. Alternatively, the effects of general anaesthesia may further contribute to the delirious state, complicating the clinical picture. Pulmonary risk stratification Risk factors for developing postoperative pulmonary complications In a systematic review of more than 100 studies, the authors identified

patient, procedure and laboratory related risk factors for the development of postoperative pulmonary complications in non-cardiothoracic surgery that were supported by good evidence. Those of interest to the fracture hip population include advanced age, American Society of Anesthesiologists class 2 or higher, functional dependence, chronic obstructive pulmonary disease and congestive heart failure, emergency surgery, general anaesthesia, prolonged surgery and serum albumin level less than 30 g/L. Interestingly, for the study population there was insufficient evidence to support preoperative spirometry as a tool to stratify risk [4]. Similar risk factors have also been incorporated into a respiratory failure risk index [5].The presence of any of these conditions should alert the primary treating doctors to request for an early anaesthetic consultation. Postoperative pulmonary complications: why does it occur? Severe factors can individually or in combination precipitate respiratory failure should the patient fail to increase and sustain the necessary minute ventilation.

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