Skip to main content Accessibility help
Hostname: page-component-5db6c4db9b-mcx2m Total loading time: 0 Render date: 2023-03-23T20:19:32.661Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true
This chapter is part of a book that is no longer available to purchase from Cambridge Core

23 - Critical care considerations and preoperative assessment for general and vascular surgery

Ian D. Nesbitt
Freeman Hospital, UK
David M. Cressey
Freeman Hospital, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
Get access


Key points

  • Perioperative cardiac complications are the most serious risk to delineate and ­ pre-emptively manage

  • Discussions between anaesthetist, surgeon and cardiologist are frequently required on a case-by-case basis

  • Critical care is an essential and rapidly developing support to many surgical procedures


‘Good surgeons know how to operate, better surgeons know when to operate, and the best surgeons know when not to operate.’ This aphorism reflects the intertwined nature of surgery, anaesthesia and critical care. Poor patient selection or preparation for a particular surgical procedure cannot be entirely compensated for by good anaesthesia or critical care. The purposes of preoperative assessment include the identification and management of individual patient risks as well as appropriate resource allocation.

Sixty per cent of patients undergoing major vascular surgery have significant coronary artery disease (CAD). Similarly, CAD is common among patients having non-vascular procedures, so an understanding of the important principles of investigation and management is important for all surgeons and anaesthetists. This section will therefore concentrate particularly on cardiovascular assessment, although other disease states are also considered.

Preoperative assessment

General preoperative assessment

When considering an individual patient, the degree of CAD is often difficult to adequately assess by history and examination alone (e.g. because of limitations in exercise capacity due to claudication, general fatigue or the time limited nature of an emergency presentation). However, a good history and examination can allow specific directed investigations to be carried out.

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 272 - 287
Publisher: Cambridge University Press
Print publication year: 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


,Cardiopulmonary Exercise Testing Website. (accessed 2 April 2009).
Deveraux, PJ, Beattie, WS, Choi, PT-L, et al. How strong is the evidence for th use of perioperative ß-blockers in non-cardiac surgery. BMJ 2005; 331(7512): 313–21.Google Scholar
,POISE Study Group, Deveraux, PJ, Yang, H, et al. Effects of extending release metoprolol succinate in patients undergoing non-cardiac surgery (POISE Trial): a radomized controlled trial. Lancet 2008; 371(9627): 1839–47.Google Scholar
Auerbach, A, Goldman, L.Assessing and reducing the cardiac risk of non cardiac surgery. Circulation 2006; 113: 1361–76.CrossRefGoogle Scholar
Vincent, JL et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996; 22: 707–10.CrossRefGoogle ScholarPubMed
,The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury. N Engl J Med 2000; 342: 1301–8.Google Scholar
Dellinger, RP et al. Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock 2008. Intensive Care Med 2008; 34: 17–60.CrossRefGoogle ScholarPubMed
Berghe, G, Wouters, P, Verwaest, C, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359–67.Google ScholarPubMed
,The NICE SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360: 1283–97.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats