In addition to a general health appraisal, the preoperative medical assessment should include a history, including history of prior surgery as well as response

to bypassing agents, and an evaluation http://www.selleckchem.com/products/gsk1120212-jtp-74057.html for comorbid conditions, such as hepatitis C or HIV infection or cardiopulmonary, renal, or liver disease, for the purposes of appropriate anaesthetic management and medication dosing. A comprehensive laboratory evaluation, including complete blood count; tests for liver and renal function; blood type; and haemostatic workup, including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, inhibitor assay, and for patients who have a low-titre inhibitor or who are undergoing immune tolerance therapy (ITT), a review of their pharmacokinetics study, which may be used to guide the

dosing frequency of factor concentrates. A thrombophilia workup (factor V Leiden, prothrombin mutation, proteins C and S, and antithrombin levels), although not routinely performed, can be undertaken in those with a prior history or family history of thrombosis. In conjunction with the pain management team, a preoperative assessment of pain and current and prior use of prescribed opioids, illicit drugs or recreational substances should be performed. Dental evaluation and treatment may click here be warranted, particularly if implantation of a prosthetic device or CVAD is expected. A physical therapy evaluation may also be warranted for patients undergoing elective orthopaedic surgery (EOS). During the initial preoperative

visit, the therapist will typically evaluate the patient’s baseline musculoskeletal and functional status and bleeding patterns in preparation for planning a postoperative rehabilitative regimen and initiate 上海皓元医药股份有限公司 a plan for preoperative therapy, or ‘prehabilitation,’ as needed [8]. In addition, the therapist can determine the necessity for mobility aids or adaptations to the home environment that may facilitate mobility and prevent injury after discharge. Additional preoperative considerations may include devising a plan for perioperative intravenous access. For long-term postoperative access, placement of a CVAD or a peripherally inserted central catheter (PICC) may be considered in lieu of peripheral access [14]. However, given that the presence of inhibitors is an independent risk factor for infection after total knee replacement (TKR) [15], the potential benefits of CVAD placement must be weighed against the risk for infection in patients with inhibitors. Patients should be advised to discontinue any non-steroidal anti-inflammatory drugs or antiplatelet agents a week prior to surgery [13]. Referral should be made to a dietician to evaluate nutritional status, since obesity or malnourishment as determined by body mass index is an important predictor of postoperative complications [16, 17].