Patients meeting any of the following criteria should be considered for an appointment prior to their elective surgery. Patients with an American Society of Anesthesiology (ASA) class of 2+, 3 or 4 are considered a candidate for optimization:
- Coronary artery disease: History of MI, heart bypass surgery, cardiac stents, PTCA or angina
- Cardiac pacemaker or implantable cardiac device (ICD)
- Atrial fibrillation and/or other cardiac arrhythmias
- Cardiac valve replacement/disease, rheumatic fever, or heart murmur
- Congestive heart failure: Current history or symptoms, or cardiomyopathy
- Peripheral vascular disease and/or stents
- Diabetes
- Obesity with BMI greater than or equal to 40
- Malnutrition
- History of difficult intubation or other known anesthesia complications
- Lung problems: Pulmonary hypertension, COPD, severe/uncontrolled asthma, recent pneumonia, chronic dyspnea or hypoxemia
- Obstructive sleep apnea
- Anemia: Iron deficiency anemia, sickle cell anemia, pernicious anemia
- Kidney disease or kidney failure
- Liver disease: Chronic hepatitis, cirrhosis, fatty liver;
- Stroke or TIA Blood clots in the legs or lungs (DVT, PE), or other blood clotting disorders
- Blood thinning medications: Heparin, Lovenox, warfarin, Plavix, Xaralto, Eliquis, Pradaxa, aspirin, etc.
- Chronic or debilitating disease requiring recent hospitalization
- Chronic immunosuppression due to medications
- Chronic steroid use
- Polypharmacy: Medication management and instruction prior to and day of surgery
- Chronic narcotic use
- Neurological diseases: Parkinson’s disease, epilepsy, stroke, multiple sclerosis, Alzheimer’s, myasthenia gravis
- Personal or family problems with anesthesia: Malignant hyperthermia or severe nausea/vomiting
Patient testing is done per anesthesia guidelines for Spectrum Health. We will arrange testing and/or consultations if necessary. The completed comprehensive evaluation and testing will be sent to the surgeon and the primary care physician prior to the surgery. Any concerns prior to the patient’s surgery will be communicated directly with the surgeon and/or their office.
ASA classifications
These classifications are a subjective assessment of a patient's overall health that is based on five classes:
- Class 1: Patient is a completely healthy fit patient
- Class 2: Patient has mild systemic disease (may be appropriate to be seen for optimization)
- Class 3: Patient has severe systemic disease that is not incapacitating (appropriate for optimization)
- Class 4: Patient has incapacitating disease that is a constant threat to life (appropriate for optimization)
- Class 5: A moribund patient who is not expected to live 24 hours with or without surgery