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Perioperative Medicine Tutorial of the Month [POMTOM]. Our regular feature to keep you on your toes.

Tutorial of the Month

16

Pre-Operative Optimisation of Respiratory Disease

Dr Owen Lewis

01 May 2018

Introduction
Anaesthetists in the UK are faced with an increasing elderly and co morbid population. Several recent papers have examined the incidence, impact and risk factors for development of postoperative pulmonary complications (PPC’s), identifying pre-operative optimisation of respiratory disease as a vital part of strategies to reduce these (1). This tutorial will focus on the diagnosis and pre-operative management of asthma, COPD and OSA.

15

Peri-operative Care of the Obese Patient

Dr D.R Tunney

16 Apr 2018

Introduction
The World Health Organisation defines Obesity as body mass index (BMI) > 30 kg/m2. This is then sub-divided into Class I (BMI 30-34.9 kg/m2), Class II (BMI 35-39.9 kg/m2) and Class III obesity (BMI >40 kg/m2).

14

Perioperative Management of anticoagulant medications

Dr Ciaran Lisboa, Morriston Hospital, Swansea

05 Feb 2018

Introduction
An increasing number of patients are now taking anti-coagulant medications or antiplatelet agents. This means there is increased risk of significant haemorrhage in the peri-operative period and care needs to be taken regarding choice of surgical and anaesthetic technique [1].

13

Practical nutritional interventions in the perioperative period: an update

Claire Cooke, Western General Hospital, Edinburgh

15 Jan 2018

Introduction
Good perioperative nutritional and metabolic management is central to the outcome of the surgical patient, and is as important as other routine considerations in the prevention of post-operative complications. This importance is reflected in the core anaesthetics curriculum (box 1).

12

Perioperative management of renin-angiotensin-aldosterone system antagonists

Ana-Catarina Pinho-Gomes, Dr Martin Beshwer & Dr Niall O'Keeffe, Manchester Royal Infirmary

06 Dec 2017

Introduction
The renin-angiotensin-aldosterone system (RAAS) antagonists include ACE inhibitors (ACEIs), angiotensin II receptor subtype 1 blockers (ARBs) and direct renin inhibitors (e.g. aliskiren). Their beneficial cardiovascular and renal effects made them key components in the therapeutic armamentarium of common diseases like hypertension[4], congestive heart failure[5], ischaemic heart disease[6] and diabetic nephropathy[7]. Therefore, most patients presenting for cardiac and non-cardiac surgery are on one or more of those drugs and the alterations they cause in cardiovascular physiology may be problematic in the perioperative setting.

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