Perioperative Medicine: Risk, Optimisation, and Complications
What you must understand
Perioperative medicine is about risk stratification and modification. Know cardiac risk indices (revised cardiac risk index, functional capacity in METs), when to investigate (and when not to), and the logic of perioperative beta-blockade, statins, and antiplatelet management. Understand the physiology of the surgical stress response (catecholamines, cortisol, cytokines) and how anaesthetic technique modulates it. Cover major complications: postoperative nausea and vomiting (Apfel score), delirium, acute kidney injury, venous thromboembolism, and perioperative myocardial injury. Also grasp enhanced recovery principles (carbohydrate loading, opioid-sparing, early mobilisation).
Traps in questions
- Ordering tests that won't change management - investigation should alter decisions.
- Assuming a high-risk patient must be delayed for optimisation when urgency dominates.
- Mixing up perioperative myocardial injury (troponin rise) with classic acute coronary syndrome.
- Forgetting that functional capacity <4 METs flags higher risk.
Worked rule of thumb
Use the "will it change management?" test. A test is justified if a positive result would alter timing, technique, or medication. Example: stable patient for elective surgery with no symptoms and good functional capacity - routine stress testing rarely changes care; optimise comorbidities and proceed. If functional capacity is poor and surgery is high-risk, consider further assessment.