Clinical Perioperative Management — Medicine and Surgery

Surgery · Clinical Specialties

How it begins

Multimodal risk assessment, physiological optimization of organ systems, control of antithrombotic therapy and accelerated recovery protocols based on contemporary clinical evidence and international guidelines.

What it covers

1. Surgery: Perioperative Management
2. Global Surgical Risk Assessment
3. · Stratification of Physical Condition: American Society of Anesthesiologists (ASA) Scale
4. · Revised Cardiac Risk Index (RCRI or Lee Index)
5. · Evaluation of Functional Capacity and Metabolic Equivalents (METs)
6. · Multivariate Predictive Tools: NSQIP MICA Calculator
7. Physiological Response to Surgical Stress
8. · Afferent and Neuroendocrine Signaling Cascade
9. · Metabolic Response: Cuthbertson Phases
10. · The Immunological and Inflammatory Cascade
11. Evaluation and Cardiovascular Risk
12. · Evaluation Algorithm in Non-Cardiac Surgery (ESC/ESAIC Guidelines 2022)
13. · Classification of Procedures According to Intrinsic Cardiovascular Risk
14. · Indications for Preoperative Diagnostic Tests
15. · The Role of Cardiac Biomarkers: NT-proBNP and hs-cTn
16. Perioperative Cardiovascular Pharmacotherapy
17. · The Beta-Blocker Controversy: Lessons from the POISE-1 Trial
18. · ACEI and ARB: Continue or Suspend?
19. · Management of Statins and Diuretics
20. Management of Antithrombotic Therapy
21. · Double Antiplatelet Aggregation (DAPT) in Patients with Coronary Stents
22. · Management of Direct Acting Oral Anticoagulants (DOACs) and Vitamin K Antagonists
23. · Bridging Therapy: Indications after the BRIDGE Trial
24. Pulmonary Risk and Management
25. · Postoperative Pulmonary Complications (PPC)
26. · Pulmonary Risk Stratification: ARISCAT Scale
27. · Pathophysiology of Atelectasis and Diaphragmatic Dysfunction
28. · Pulmonary Prevention and Optimization Strategies
29. · Obstructive Sleep Apnea (OSA): STOP-BANG Screening Questionnaire
30. Kidney Function and Perioperative Hydration
31. · Postoperative Acute Kidney Injury (AKI)
32. · Perioperative Fluid Therapy: Liberal vs. Restrictive (RELIEF Trial)
33. · Goal Guided Fluid Therapy (GDTP / GDFT)
34. · Perioperative Sodium Disorders: Acute Hyponatremia
35. Glycemic Control and Endocrine Disorders
36. · Perioperative Glycemic Control: Lessons from the NICE-SUGAR Trial
37. · Management of Oral and Non-Insulin Antidiabetics
38. · Secondary Adrenal Insufficiency and Stress Steroid Therapy
39. Antimicrobial Prophylaxis and Infection Control
40. · Antibiotic Administration and Selection Criteria
41. · The 60 Minute Rule and Redosing Criteria
42. · Regimes of Choice according to Surgical Location
43. Hemostatic Management and Perioperative Transfusion
44. · Transfusion Strategy: Restrictive vs. Liberal (TRICS III Test)
45. · Viscoelastic Coagulation Tests: TEG and ROTEM
46. · Use of Perioperative Antifibrinolytics: POISE-3 Trial
47. Management of the Elderly and Frail Patient
48. · Frailty as an Independent Predictor of Complications
49. · Postoperative Delirium (POD) vs. Postoperative Cognitive Dysfunction (POCD)
50. · Non-Pharmacological Delirium Prevention Strategies (HELP Protocol)
51. · Polypharmacy and Inappropriate Prescription: Beers Criteria
52. ERAS / Fast-Track protocols
53. · Components of a Multimodal ERAS Protocol
54. Multimodal Analgesia and Pain Control
55. · The Multimodal Analgesia Paradigm
56. · Adverse Effects of Indiscriminate Use of Opioids
57. · Prevention and Management of Postoperative Nausea and Vomiting (PONV)
58. Major Postoperative Complications
59. · Postoperative Fever: The Diagnostic Rule of the "5 Ws"
60. · Venous Thromboembolism Prophylaxis: Caprini Scale
61. · Postoperative Paralytic Ileus and Anastomosis Dehiscence