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Abstract
Evidence suggests that the perioperative period may have long-term health consequences. The preoperative evaluation may be a “window of opportunity” for preventive care and improvement in chronic therapies as well as a motivating, life-altering period for patients, so physicians and perioperative caregivers must expand and develop processes with this in mind. The high-risk patient who needs noncardiac surgery continues to represent a dilemma with respect to the appropriate degree of preoperative diagnostic testing. In patients with known cardiovascular disease (CVD), information on its extent and stability and on ventricular function may be beneficial in directing perioperative management. Many patients, particularly those who will undergo major vascular surgery, may be asymptomatic, and no prior or recent evaluations may have been performed; however, the probability of extensive coronary artery disease (CAD) may be high., Anesthesiologists face several preoperative challenges when patients with endocrine disorders need surgery. Patients may present with an endocrinopathy requiring surgery, or more commonly, have an endocrine abnormality that complicates surgical and anesthetic management. The term renal impairment or renal disease encompasses a broad spectrum of disease. This continuum ranges from the asymptomatic patient with mildly elevated serum creatinine to the patient with chronic renal failure (CRF) who is dialysis dependent. The broad spectrum makes management of patients with renal disease during the perioperative period challenging.