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patients_at_increased_risk_anesthesia_complications [2026/09/20 08:54] – created Scott Larsonpatients_at_increased_risk_anesthesia_complications [2026/09/20 09:20] (current) – Scott Larson
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 ====== Patients at Increased Risk of Anesthesia Complications during Outpatient Surgery ====== ====== Patients at Increased Risk of Anesthesia Complications during Outpatient Surgery ======
  
 +===== BMI =====
 +  * BMI Greater than 50.
 +
 +===== Airway/Respiratory =====
 +  * History of difficult airway or difficult airway on exam.
 +  * Cervical fusion MAY mean difficult airway 
 +  * Down's syndrome with an unstable neck. This means a difficult airway. We are not obtaining C-spine (flexion, extension) films on Down's patients every 2 years any longer.
 +  * Specific Difficult airway syndromes, such as Pierre Robin and Treacher Collins
 +  * Severe COPD (we can always review these for you), but these patients may require post-op intubation.
 +===== Rheumatoid Arthritis =====
 +  * Patients may need C-spine (flexion, extension) films if they have pain with movement look for c-spine instability
 +===== Cardiac Concerns =====
 +  * Complex Congenital cardiac history that had cardiac surgery.
 +    * Hypoplastic left heart
 +    * Tetralogy of Fallot.
 +    * Heart Transplant patients
 +    * An ASD or VSD is less risk if the patients oxygen saturations >90% at rest and activity. If yes **__and__** if they can maintain normal activity 
 +  * EF Less than 40%.
 +  * Cardiac Pacers- may need EP recommendations for the OR.
 +  * AICDs only for MAC and regional cases 
 +  * New onset chest pain
 +  * A-fib.
 +  * MI or stent placement should wait 3 mos after intervention
 +  * Any patients with new onset cardiac concerns (SOB, chest pain, syncope, etc.) should have work-up prior to surgery
 +
 +===== Kidney Concerns =====
 +  * Renal failure patients that need dialysis
 +
 +===== Liver Concerns =====
 +  * Liver failure patients with high MELD scores
 +  * Consider coagulation studies pre-op
 +===== Sickle Cell Disease =====
 +  * Sickle cell disease 
 +
 +===== Parkinson's Disease =====
 +  * Parkinson's Disease or other neuromuscular diseases with respiratory or bulbar symptoms (these patients will likely need to be intubated post-op)
 +
 +===== Seizure Patients =====
 +  * **__if__** the seizures are **__not__** multiple times per day.
 +  * If they have an implantable device for their seizures, please call, as they will need special equipment for the surgery that may need to have that available a few days in advance (this is also true with Parkinson patients with devices and nerve stimulators as well). Patient with implantable devices will need to turn off device for surgery likely.
 +
 +===== Stroke/TIA =====
 +  * Documented stroke should wait 3 mos before surgery in the ASC
 +  * TIA symptoms should wait 3 mos before surgery in the ASC - can request Medical Director review
 +
 +===== Mitochondrial Myopathy =====
 +  * 
 +
 +
 +===== Pregnancy =====
 +  * Pregnant patients in second trimester are at lower risk
 +  * Fetal heart tones should be monitored pre- and post-op.
 +
 +===== Colds and Pneumonia, Fever: Wait for surgery for... =====
 +  * 2 weeks if there is not history of asthma or COPD for a simple URI
 +  * 4 weeks if there is a history of asthma or COPD for simple URI
 +  * 4 weeks for pneumonia/bronchitis for a patient without asthma or URI
 +  * 6 weeks for pneumonia/bronchitis for a patient with asthma or URI (COVID pneumonia would fall in this category)
 +  * Patients with fever, nausea and vomiting the night before should be rescheduled
 +
 +===== Malignant Hyperthermia =====
 +  * Discuss with anesthesia team at time of scheduling
 +
 +{{tag>preop surgery strabismus_surgery guidelines}}