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Overview :
Buth et al listed 7 categories used when determining if a
patient may be unfit for general anesthesia and/or major surgery. This can help
identify patients who may benefit from an alternative therapy or who should be
informed of the risk prior to any operation. The authors are from the EUROSTAR
Data registry and involved multiple hospitals in Europe.
NOTE: The categories were collected in patients undergoing
abdominal aortic aneurysm repair. The same categories can be used for other
conditions.
Categories:
(1) severe
cardiovascular disease (severe ischemic heart disease, severe cerebrovascular
disease, status post heart transplant, other)
(2) severe
pulmonary disease
(3) conditions
with significant combined cardiopulmonary impairment
(4) cancer
(5) local anatomic factors (see below)
(6) disorders of other organs or systems
(6a) rheumatologic (rheumatoid
arthritis, vasculitis, other
(6b) hematologic disorders
(6c) coagulation disorders
(bleeding or hypercoagulability)
(6d) renal (renal failure, hemo or
peritoneal dialysis)
(6e) liver disease
(6f) neurologic disorders
(Parkinson's disease, paraplegia, other)
(6g) psychiatric disease
(6h) muscular disorders
(myasthenia, muscular dystrophy)
(6i) endocrine disorders (severe
diabetes, thyroid, adrenal, other)
(7) poor
overall physical condition (ASA class 4 or 5, very young or very advanced age,
severe comorbid conditions)
Local conditions that may affect surgery:
(1) history of previous operations at site with multiple
adhesions and/or scarring
(2) diffuse fibrosis at the site from other causes
(3) concurrent infection at site (osteomyelitis, other)
(4) concurrent inflammatory conditions (pancreatitis, other)
(5) severe obesity or fat accumulation
(6) transplanted organ in operative field
(7) history of radiation therapy
(8) severe vascular disease
Some conditions will result in permanent deferral while
other may be temporary.
NOTE: Something else to include would be a history of
complications following previous procedures and/or general anesthesia that are
likely to be recurrent.
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