The Perioperative Medicine Consult Handbook

279 Pages·2013·2.056 MB·English

by  Kara J. Mitchell MD, Christopher J. Wong MD (auth.), Christopher J. Wong, Nason P. Hamlin (eds.)

The Perioperative
Medicine Consult
Handbook

The Perioperative
Medicine Consult
Handbook
Christopher J. W ong, MD
Department of Medicine, Division of General
Internal Medicine, University of Washington
Medical Center, Seattle, Washington, USA
Nason P. H amlin, MD, FACP
Department of Medicine, Division of General
Internal Medicine, University of Washington
Medical Center, Seattle, Washington, USA
Editors
Christopher J. W ong, MD
Department of Medicine
Division of General Internal Medicine
University of Washington Medical Center
Seattle, W A, USA
Nason P. H amlin, MD, FACP
Department of Medicine,
Division of General Internal Medicine
University of Washington Medical Center
Seattle, WA, USA
ISBN 978-1-4614-3219-7 ISBN 978-1-4614-3220-3 (eBook)
DOI 10.1007/978-1-4614-3220-3
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2012950321
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Dedication
We dedicate this book to Dominic F. “Dom” Reilly, MD and Diane
Doerner, MD and to our patients.

Preface
Perioperative medical consultation is an exciting and evolving fi eld of
medicine. At the University of Washington Medical Center, medicine
consultation as a separate endeavor began in the late 1980s with gen-
eral medicine attendings taking medicine consultation calls in addi-
tion to their primary care practices. In the early 1990s, a formal
Medicine Consult Service was developed, with early pioneers includ-
ing Dominic Reilly, MD, and Diane Doerner, MD. Patients were seen
on the inpatient wards and in the surgical clinics. By 1995, however,
the Medicine Consult Service began its own small clinic in a shared
space. Over the ensuing years, the Medicine Consult Service has
expanded in number of staff, patients seen, and clinic size. Our focus
has been on the evaluation of medically complex patients undergoing
noncardiac surgery.
Collaboration and continuity have been hallmarks of the service:
■ In November of 2003 the Medicine Consult Clinic moved into
the Surgical Pavilion, in close proximity to the Pre-Anesthesia
Clinic and the Surgical clinics. This location fosters close con-
tact with the perioperative team.
■ A unique feature of this service has been its continuity—the
same provider who performs the preoperative evaluation also
sees the patient postoperatively (see Chap 2, Styles of Medical
Consultation). In the current hospitalist era, it is a way in which
a general internist can still practice inpatient and outpatient
medicine at the same time.
The Medicine Consult Service has always maintained its teaching mis-
sion, with housestaff and medical students rotating through the ser-
vice. In addition, in the course of performing clinical consultation, we
also serve as educators for the surgical residents, holding the belief that
a surgeon who knows more medicine will provide better overall care.
The fi rst edition of The Medicine Consult Handbook was published
in 2006 as a resource for residents and junior faculty regarding the
vii
viii PREFACE
science and art of perioperative medicine. As the evidence base for
perioperative practice has expanded, so too has this handbook. We
have attempted to provide a balanced presentation that includes edu-
cation, evidence, common situations, guideline-based care, and pearls
of wisdom, while not emphasizing practices that may be unique to
our own institution. For the sake of point-of-care use, we have favored
brevity and included references to a subset of the perioperative medi-
cine literature, rather than creating comprehensive chapters better
suited to a traditional textbook.
How to use this book: For those just starting in perioperative medi-
cine, we recommend reading Chap 3: The Preoperative Evaluation,
Chap 4: Perioperative Medication Management, Chap 6: Cardiovascular
Risk Stratifi cation, and Chap 13: Pulmonary Risk Assessment and
Management as a general overview. Other topics may be reviewed as
needed depending on one’s practice setting and the types of patients
seen.
Even with the increasing guidelines and evidence, perioperative
medicine remains an art and, as always, there may be local practices
that are different from those presented in this book. We fully expect
the practice of perioperative medicine to continue to change and
welcome your comments and feedback.
Christopher J. Wong, MD Seattle, W A, USA
Nason P. Hamlin, MD, FACP March 2012
Acknowledgments

Perioperative Management of the Patient with Rheumatologic
Disease
Gregory C. Gardner, MD , P rofessor, Rheumatology , University of
Washington
Valvular Heart Disease
Philip A. Vedovatti, MD
Implantable Cardiac Devices
Philip A. Vedovatti, MD
Perioperative Diabetes Management
Irl B. Hirsch, MD , Professor of Medicine , University of Washington
Anthony DeSantis, MD , Clinical Assistant Professor of Medicine ,
University of Washington
Janet Kelly, PharmD , Clinical Professor, Dept. of Pharmacy, School of
Pharmacy, University of Washington
Cindy Sayre, ARNP , D irector/Assistant Administrator, Patient Care
Services , University of Washington
Ischemic Heart Disease
Steven L. Goldberg, MD, Clinical Associate Professor of Medicine,
Division of Cardiology, University of Washington
Laurie A. Soine, PhD, ARNP, Teaching Associate in the Department of
Radiology and Department of Medicine, Division of Cardiology,
University of Washington
Surgical Procedures Overview
John L. Gore, MD , Assistant Professor, Department of Urology , University
of Washington
Daniel W. Lin, MD , Associate Professor, Department of Urology ,
University of Washington
ix