Preanesthetic Assessment 2
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Also talking to patients about their particular wishes is important, especially after reviewing the type of anesthetic options available and the risks, benefits, and alternatives of each treatment option. Equally important to safety of delivered anesthetic is to realize the patients fears and concerns i. Patients who are in optimal living conditions and who are undergoing a procedure with minimal risks do not need preoperative labs [Roizen eds : Advances in Anesthesia p, ]. In the past EKG has been recommended at 40 years of age for men for all general anesthetics women at However, recent data suggests this will lead to considerable over-testing.
Patients at higher risk of having significantly abnormal electrocardiograms which would potentially affect management were those older than 65 yr of age or who had a history of heart failure, high cholesterol, angina, myocardial infarction, or severe valvular disease. Five patients 0. Operative factors in considering ECG and other tests include the type of surgery, the expected blood and fluid shifts, and the operative duration should influence the pre-operative tests required.
The United Kingdom National Institute for Health and Clinical Excellence NICE issued a guideline on this topic in based on a systematic review of the literature, and this guidance can be found here.
This is a complex and nuanced guideline which emphasizes comorbidities and concurrent illness in considering testing and looks broadly at testing including renal function and blood gases. Overall, these data provide strong support for the feasibility of enrolling patients and their families to participate in a brief, neurocognitive assessment prior to undergoing surgery. One such impediment was working around the multiple demands and scheduled procedures that families faced prior to children's surgery eg, presurgical scans, visits from health care personnel, family visitation.
Additionally, the typical window from time of referral from the medical team to complete testing was approximately 24 to 48 hours. Given this tight window it was not possible to conduct testing in all cases.
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Insufficient time between referral and surgery was an issue for 4 of the children enrolled. Parents often appeared overwhelmed and if they did not complete the measures during their hospital stay, the measures most often were not returned. Therefore, future studies should emphasize the need for parents to complete measures prior to or during the child's hospital stay as well as to coordinate efforts for questionnaire completion with nursing staff.
Importantly, although one may suspect that the children would be too distressed to complete testing, level of distress only prevented testing for 1 child in our sample. The second primary aim of this study was to present initial findings from our brief neurocognitive test battery.
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The results of intellectual functioning were below the population mean but within the average range. However, approximately one third of patients fell one or more standard deviations below the normative mean, which is approximately twice what is expected in the normal distribution. Similarly, with regard to parents' reports of their children's neurocognitive functioning, scores also fell in the age-expected range; however, the sample mean scores indicated significant impairment relative to the normative mean with a half of a standard deviation elevation for the BRIEF GEC ratings.
Moreover, over one-third of patients' parent-reported GEC T- scores fell 1 or more standard deviations above the normative mean, which is more than double the expected rate. Given the relatively increased rates of difficulty in a subgroup of this sample as measured by both direct assessment and parent report, these baseline markers of functioning are critical to understand and correctly attribute disease and treatment factors that may or may not be related to trajectories of functioning over time.
However, it is also noteworthy that both parent-report and performance-based scores indicate that children in this study of pretreatment functioning were faring better relative to the large effect sizes noted in a recent meta-analysis of pediatric brain tumor survivors. Despite its strengths, the present study has several limitations.
The sample is highly variable with regard to age and tumor type, which makes it difficult to interpret how these factors relate to functioning. It is also noteworthy that as found in other studies, 21 performance-based measures of intellectual functioning were not related to parent-report measures of this construct.
Further research is needed to continue to understand the meaning of these 2 indices of children's cognitive function. Furthermore, the small size of the current sample prevented group comparisons of neurocognitive functioning by demographic factors eg, gender or tumor characteristics eg, tumor grade, location. It is also unclear whether some factors, such as presence of a space-occupying lesion, hydrocephalus, transient visual loss, hearing impairment, or neuroendocrine dysfunction, are reversible.
Future studies should include multiple sites in order to accrue large samples to systematically analyze the aforementioned effects. Finally, the findings from this study have significant implications for future research and clinical practice. It will be important to compare children's preoperative testing with their postoperative and follow-up testing.
Additionally, plotting trajectories of children's functioning will help to identify critical points of intervention and factors related to declines in functioning.
It will be important to consider moderators, both risk and protective factors, that will inform intervention efforts to prevent or abate negative effects for brain tumor survivors and their families. This research was supported by a gift from an anonymous donor and in part by a grant from the National Cancer Institute R21 CA Oxford University Press is a department of the University of Oxford.
It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume 3. Article Contents. Materials and Methods. Presurgical assessment of cognitive function in pediatric brain tumor patients: feasibility and initial findings Jennifer C. Oxford Academic. Google Scholar. Matthew Pearson. Kristen E. Charissa Andreotti.
Jennifer P. Kelly H. Leandra Dejardins. Lindsay Holmes.
2 Preanesthetic Assessment for Thoracic Surgery
Rebecca Byram. Claire Fraley. Bruce E. Cite Citation. Permissions Icon Permissions. Abstract Background. Supra, supratentorial; infra, infratentorial; PNET, primitive neuroectodermal tumor. Open in new tab. Summary of patient demographics, tumor characteristics, and neurocognitive functioning.
Open in new tab Download slide. Flow diagram of patients through the study from admission to neurocognitive testing.
Preanesthetic assessment - Wikipedia
Search ADS. Adverse late effects of childhood cancer and its treatment on health and performance. Neuroimaging of pediatric brain tumors: From basic to advanced magnetic resonance imaging MRI. Brain Tumor Progress Review Group. A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors.
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