Preoperative Care

  • The preoperative bleeding time test: assessing its clinical usefulness
    Amy S. Gewirtz, MD, Kandice Kottke-Marchant, MD, PhD and Michael L. Miller, DO
    Cleveland Clinic Journal of Medicine November 1995, 62 (6) 379-382;

    Because of the bleeding time test's low value in predicting perioperative bleeding, it should be abandoned as a routine screening test.

  • Evaluating cardiac risk in noncardiac surgery patients
    David L. Bronson, MD, Alan K. Halperin, MD and Thomas H. Marwick, MD, PhD
    Cleveland Clinic Journal of Medicine November 1995, 62 (6) 391-400;

    The history, examination, and resting EKG are the cornerstone of cardiac risk assessment, but new techniques are available for questionable cases.

  • The changing profile of anesthetic practice: an update for internists
    Thomas L. Higgins, MD
    Cleveland Clinic Journal of Medicine May 1993, 60 (3) 219-232;

    BACKGROUND Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught.

    OBJECTIVE To update internists on recent changes in anesthetic management and how they affect the preoperative evaluation.

    SUMMARY Recent advances in anesthetic management include new monitoring standards, balanced anesthetic technique, new agents, equipment changes, better understanding of human factors, and expanded pain management techniques.

    CONCLUSIONS Postoperative care will likely assume increasing importance in determining anesthesia-related morbidity and mortality. For this reason, increased interaction and cooperation between surgeons, internists, and anesthesiologists are needed.

  • Monoamine oxidase inhibitors and elective surgery
    Zeyd Y. Ebrahim, MD, Jerome O’Hara, MD, Lester Borden, MD and John Tetzlaff, MD
    Cleveland Clinic Journal of Medicine March 1993, 60 (2) 129-130;

    This retrospective study of 32 patients challenges the notion that use of these agents is a contraindication for elective surgery.