الفهرس 
Definition of high risk surgical patientsOnly 14 pages are availabe for public view
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Abstract
The high risk surgical patient is the patient at risk of morbidity and mortality due to coexistent disease and or the severity of the surgery. Several classification were established for stratification of high risk surgical patients depending on risk factors associated with each type of patients. ASA physical status classification is the most common used. For optimization to be done, risk assesment must be done firstly to categorize each each patient regarding severity of his/her condition.
Cardiac patients can be stratified by several risk indices including Goldman risk index , Eagls cardiac index, Detesky cardiac index, revised Lee cardiac index and American College of Cardiology risk index. To optimize cardiac patients: firstly, history and physical examination must be done accurately to put the plan for further investigations. Risk assessment of high risk surgical patients with pulmonary diseases is by determining risk factors that include patient factors and surgical factors. For high risk surgical patients with kidney disease, surgical risk depends on type of surgery whether the procedure is routine or emergency, extent of renal impairment and presence of co morbidities. To stratify patients with chronic liver disease there are Child classification and Meld score. Risk assessment for patients with neurological diseases includes physical and neurological examination with special concern about conscious level and preoperative laboratory and imaging investigations.
Optimization of cardiac condition can be done either by revascularization or by medical therapy. Optimization of high risk patients with pulmonary diseases is by doing necessary investigations like chest radiographs, PFT and blood gases. Upon these investigations risk index for postoperative respiratory complications can be established and then putting strategies to optimize chest conditions. Optimization of patients with kidney disease is by guarding against magor complications occurring perioperatively which include: hyperkalemia with keeping accepted K level, acid base disturbsnce with correction of any abnormality, guarding against perioperative bleeding with correction of anemia if present, antibiotic prophylaxis, choice of correct IV fluids, avoidance of nephrotoxins and lastly using drugs to guard against acute kidney injury. Optimization of hepatic patients preoperative depends on the type hepatic disease with special recommendations for each condition. These conditions are: acute hepatitis, hepatic patients with respiratory compromise, alcoholic hepatitis, and chronic hepatitis with liver cirrhosis, obstructive jaundice, and patients scheduled for hepatic resection, autoimmune hepatitis and wilson disease. Optimization of hepatic patients is done by correction of hypoalbuminemia, treating ascites, treatment of hepatic encephalopathy, treatmnent of hepatopulmonary syndrome and treating and guarding against variceal bleeding. Optimization of neurological conditions differ according the primary aetiology with special recommendations for each disease. Generally medical conditions must be optimized and deiesion about continuing or stopping there medications preoperatively must be determined to exacerbation or occurring of another neurological insult perioperatively. Special recommendations for optimization of each neurologic diease like neuromuscular disorder, Parkinson disease, previous stroke.