Preoperative Assessment of the High-Risk Elderly

  • John A. Savino
Part of the Contemporary Geriatric Medicine book series (COGM, volume 3)


The ability of patients to meet the stresses of surgery and anesthesia should be assessed in the preoperative period in order to quantitate the cardiovascular, respiratory, and metabolic functional deficits. The high-risk patient who must undergo surgery presents a judgment decision for the internist, surgeon, and patient. Unfortunately, preoperative risk assessment without optimization of the patient does little to diminish intraoperative and postoperative morbidity and mortality.


Cardiac Output Obese Patient Cardiac Index Pulmonary Capillary Wedge Pressure Preoperative Assessment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Goldman, L., Calderea, D. L., Nussbaum, S. B., et al, 1977, Multifactional of cardiac risk in noncardiac surgical procedures, N. Engl J. Med. 297:845.PubMedCrossRefGoogle Scholar
  2. 2.
    Del Guercio, L. R. M., 1979, Physiologic monitoring of the surgical patient, in: Principles of Surgery (S. Schwartz, ed. ), McGraw-Hill, New York, pp. 525- 545.Google Scholar
  3. 3.
    Del Guercio, L. R. M. and Cohn, J. D., 1980, Monitoring operative risk in the elderly, JAMA 243:1350–1355.PubMedCrossRefGoogle Scholar
  4. 4.
    Vaconti, C. J., Ban Houten, R. J., and Hill, R. C., 1970, A statistical analysis of the relationship of physical status to postoperative mortality in 68, 388 cases, Anesth. Analg. Curr. Res. 49:564—566.Google Scholar
  5. 5.
    Cohn, J. D., Engler, P. E., and Del Guercio, L. R. M., 1975, The automated physiologic profile, Crit. Care Med. 3:51—58.PubMedCrossRefGoogle Scholar
  6. 6.
    Agarwal, N., Shibutani, K., Sanfilippo, J. A., Del Guercio, L. R. M., 1982, Hemodynamic and respiratory changes in surgery of the morbidly obese. Surgery 92:226–243.PubMedGoogle Scholar
  7. 7.
    Bursztein, S., Taiterman, U., Mythenaere, S. D., et al, 1978, Reduced oxygen consumption in catabolic states with mechanical ventilation, Crit. Care Med. 6:162.PubMedCrossRefGoogle Scholar
  8. 8.
    Goldfarb, R. D., 1982, Cardiac mechanical performance in circulatory shock: A critical review of methods and results, Circ. Shock 9:633.PubMedGoogle Scholar
  9. 9.
    Lee, K. Y., Molloy, D. W„ Slykerman, L., et al, 1983, Effects of hydralazine and nitroprusside on cardiopulmonary function when a decrease in cardiac output complicates a short-term increase in pulmonary vascular resistance. Circulation 68:1299.PubMedCrossRefGoogle Scholar
  10. 10.
    Clowes, G. H., Farrington, G. H., Zuschneid, W., et al, 1970, Circulating factors in the etiology of pulmonary insufficiency and right heart failure accompanying severe sepsis (peritonitis), Ann. Surg. 171:663.PubMedCrossRefGoogle Scholar
  11. 11.
    Packer, M., Meiler, J., Medina, N., et al., 1980, Dose requirements of hydralazine in patients with severe congestive heart failure. Am. J. Cardiol. 45:655.PubMedCrossRefGoogle Scholar
  12. 12.
    Lakatta, E. S. and Yin, F. C. P., 1982, Myocardial angina: Functional alterations and related cellular mechanisms. Am. J. Physiol. 242:H927.PubMedGoogle Scholar
  13. 13.
    Goldstein, J. A., Tyberg, J. V., Parmley, W. W., et al, 1983, Volume loading improves low cardiac output in experimental right ventricular infarction, J. Am. Coll. Cardiol. 2:270.PubMedCrossRefGoogle Scholar
  14. 14.
    Brent, B. N., Berger, H. J., Matthay, R. A., et al, 1982, Physiologic correlates of right ventricular ejection fraction in chronic obstructive lung disease: A combined radionuclide and hemodynamic study. Am. J. Cardiol. 50:255.PubMedCrossRefGoogle Scholar
  15. 15.
    Babu, S. C., Sharma, P. V., Raciti, A., et al., 1980, Monitor-guided responses, Arch. Surg. 115:1384.PubMedCrossRefGoogle Scholar
  16. 16.
    Babu, S. C., Shah, P. M., and Claus, R. H., 1982, Unappreciated causes of ischemia in the leg. Am. J. Surg. 144:225.PubMedCrossRefGoogle Scholar
  17. 17.
    Shultz, R. J., Whitfield, G. F., and Lamura, J. J., 1985, Role of physiologic monitoring in patients with hip fractures, J. Trauma 25:309–316.CrossRefGoogle Scholar
  18. 18.
    Garcras, V. A., Malloun, C., Park, T., et al., 1981, Depressed myocardial function after transurethral resection of prostate, Urology, 17:420.CrossRefGoogle Scholar
  19. 19.
    Jabbour, I., Savino, J. A., Agarwal, N., and Byrne, D., 1986, Pneumatic antishock garments detrimental in elderly with diminished myocardial reserve, Curr. Surg. 43(6):498–501.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • John A. Savino
    • 1
  1. 1.Department of SurgeryNew York Medical CollegeValhallaUSA

Personalised recommendations