Mind Map Series Anesthesia Pre-Visit and Evaluation Expert Consensus (3)

Appendix (text part of the guide)

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Recommendations: (1) Patients with diabetic ketoacidosis and hypertonic syndrome should postpone elective surgery; (2) On the day of surgery, diabetic patients should stop oral hypoglycemic drugs and non-insulin injections, monitor blood glucose during drug discontinuation, and use conventional insulin to control blood glucose levels; (3) Patients with long-term diabetes mellitus should be assessed in detail for their difficult airways and risk of cardiovascular adverse events11

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Recommendations: (1) Patients with hyperthyroidism must be stabilized by active treatment before they can undergo elective surgery; (2) Antithyroid drugs and β blockers should be continuously applied to the morning

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3 Hypothyroidism: (1) the cause and severity of hypothyroidism; (2) Whether to take thyroxine replacement therapy; (3) Whether the thyroid gland is enlarged and compresses the trachea, whether there is a difficult airway
.

Recommendations: (1) Thyroxine should be taken until the morning of the day of surgery; (2) Patients with severe hypothyroidism or mucoedema and coma, elective surgery should be performed
after active treatment.

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4 Pheochromocytoma: (1) whether there are clinical symptoms such as persistent or paroxysmal hypertension, episodic headache, sweating and palpitations; (2) Whether 24h urine and plasma free methoxyephrine and blood or urine catecholamines are abnormal; (3) Whether there are abnormalities in hematocrit, erythrocyte sedimentation rate, blood glucose and glucose tolerance; (4) The length of the disease, whether there is catecholamine cardiomyopathy
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Recommendations: (1) If necessary, start the application of antihypertensive drugs and expansion therapy 2 weeks before surgery; (2) Closely monitor blood pressure every day before surgery; (3) Ask the Urology Department to jointly assess the intraoperative risk
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Risk assessment: in patients with comorbid endocrine disease, the primary disease needs to be evaluated in detail before surgery, and the evaluation of complications is particularly important, and further evaluation
by a specialist if necessary.

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5 Diseases of the digestive system

Liver disease: (1) understand the cause and severity of liver disease; (2) Whether there are complications such as hypoproteinemia, anemia, portal hypertension, hepatorenal syndrome and hepatic encephalopathy; (3) Understand the treatment method and treatment drugs
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Recommendations: (1) Acute severe hepatitis may lead to aggravation of perioperative liver function damage, and even liver failure, and it is recommended to postpone elective surgery; (2) Patients with complications such as severe hypoproteinemia or anemia should be actively treated before implementation; (3) Assess whether liver function can tolerate surgery
.

Risk assessment: Routine liver function assessment is recommended in patients with hepatic insufficiency or liver disease, and patients with cirrhosis can be quantitatively assessed for liver reserve function according to the Child-Pugh grading criteria (Table 5
).

 

Table 6 Child-Pugh grading criteria

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6 Diseases of the urinary system

Kidney disease: (1) understand the cause and severity of impaired kidney function; (2) Whether there is an acid-base imbalance and water-electrolyte disorder; (3) Ask whether there are symptoms and signs such as oliguria, dysuria, edema and dyspnea; (4) Understand the treatment method and the treatment drug
.

Recommendations: (1) Before surgery, it is necessary to actively correct high potassium or severe metabolic acidosis before selective surgery; (2) Assess whether residual renal function can tolerate surgery; (4) Patients with uremia dialysis should undergo dialysis treatment
before undergoing high-risk surgery.

Risk assessment: routine renal function assessment is recommended in patients with renal disease; For all patients with kidney disease requiring surgery, it is recommended to estimate the glomerular filtration rate (GFR) according to the Chronic Kidney Disease Epidemiological Collaboration (CKnEPI) formula to assess renal function and the risk of acute kidney injury after surgery; Appropriate preoperative prophylaxis strategies (e.
g.
, caution with nephrotoxic drugs and contrast agents) or joint evaluation by a nephrologist must be considered to reduce the risk
of postoperative renal failure.

 

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7 Diseases of the blood system

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1 Anemia: (1) The cause, type and severity of anemia; (2) Current treatment methods
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Recommendations: (1) Blood transfusion therapy is recommended for elderly patients with severe anemia (hemoglobin <7 g/dl) before undergoing high-risk surgery; (2) When patients with elective surgery are diagnosed with iron deficiency anemia before surgery, it is recommended to supplement iron or erythropoietin for 2-4 weeks to correct anemia and reduce perioperative transfusion complications
.

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2 Coagulation dysfunction: (1) whether the patient has a history of bleeding or thromboembolism; (2) Laboratory examination is abnormal; (3) Whether you are currently taking hemostatic or anticoagulant drugs
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Recommendations: (1) Patients with hypercoagulable states should be assessed for perioperative thrombosis risk before surgery; (2) Patients with coagulation dysfunction should avoid nerve block or spinal canal anesthesia
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Risk assessment: Perioperative thromboembolism risk and surgical bleeding risk assessment is recommended for all patients
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Based on the results of the assessment, a perioperative anticoagulant management plan is reasonably formulated
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Editor-in-Chief / Wu Haotian

This article is edited / Wu Xiaobin

Chief Proofreader / Lu Yiran