Our Summary
This research paper discusses the importance of risk assessment for patients with heart diseases who are about to undergo non-heart related surgeries. The risk is influenced by the type of operation, the patient’s disease and risk profile, including their age. In some cases, if the risk related to the surgery is low, it may not be necessary to have a specialist check the patient before the surgery. To decide whether a specialist examination is needed, doctors can consider the patient’s symptoms, like their ability to exercise, and measure certain markers in the blood such as troponin and NT-proBNP. It is also advised that if a patient is already on heart medication, they should continue taking it around the time of the surgery, but they shouldn’t start new heart medication just for the operation. There are established guidelines for when to pause blood thinners before surgery, but using heparin as a “bridge” is no longer recommended.
FAQs
- How is the risk assessment conducted for patients with heart diseases who need to undergo non-heart related surgeries?
- What factors are considered to determine if a specialist examination is needed before surgery for heart disease patients?
- What is the recommendation regarding the continuation of heart medication during the time of non-heart related surgeries?
Doctor’s Tip
A helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative instructions carefully, including fasting guidelines and medication protocols. It is important to disclose all medications, supplements, and medical history to your healthcare team to ensure a safe surgery and recovery. Additionally, it is crucial to have a support system in place for after the surgery to help with recovery and rehabilitation. It is also important to follow up with your healthcare team for regular check-ups and monitoring after the surgery.
Suitable For
Patients who are typically recommended for brain surgery include those with:
Brain tumors: Patients with brain tumors may require surgery to remove or reduce the size of the tumor, depending on the type and location of the tumor.
Epilepsy: Patients with epilepsy that is not well controlled with medication may be candidates for surgery to remove the part of the brain causing seizures.
Traumatic brain injuries: Patients with severe traumatic brain injuries may require surgery to reduce swelling, remove blood clots, or repair damaged tissue.
Hydrocephalus: Patients with hydrocephalus, a condition where there is an accumulation of fluid in the brain, may require surgery to insert a shunt to drain the excess fluid.
Aneurysms and arteriovenous malformations: Patients with aneurysms (weak spots in blood vessels that can rupture) or arteriovenous malformations (abnormal tangles of blood vessels) may require surgery to repair the abnormality and prevent bleeding.
Parkinson’s disease: Patients with Parkinson’s disease who do not respond well to medication may be candidates for deep brain stimulation surgery, where electrodes are implanted in the brain to help control movement.
Chiari malformation: Patients with Chiari malformation, a condition where brain tissue extends into the spinal canal, may require surgery to create more space and relieve pressure on the brainstem.
Overall, patients recommended for brain surgery are those who have conditions that cannot be effectively treated with medication alone and who may benefit from surgical intervention to improve their symptoms and quality of life.
Timeline
Before brain surgery:
Consultation with a neurosurgeon: The patient meets with a neurosurgeon to discuss the reason for surgery, potential risks and benefits, and what to expect during the procedure.
Pre-operative testing: The patient may undergo various tests such as imaging scans (CT scan, MRI), blood tests, and electroencephalogram (EEG) to assess their brain function and overall health.
Preparing for surgery: The patient may need to stop taking certain medications, refrain from eating or drinking for a specified period of time before surgery, and make arrangements for post-operative care.
Surgery: The patient undergoes the brain surgery, which can vary depending on the specific condition being treated (e.g. tumor removal, aneurysm clipping, epilepsy surgery).
After brain surgery:
Recovery in the hospital: The patient is closely monitored in the hospital for any complications, such as bleeding, infection, or changes in neurological function. Pain management and rehabilitation may also be initiated.
Discharge and follow-up care: Once stable, the patient is discharged from the hospital with instructions on wound care, medications, activity restrictions, and follow-up appointments with their healthcare team.
Rehabilitation: Depending on the type of brain surgery and the patient’s condition, they may need ongoing rehabilitation therapy to regain lost function, such as speech therapy, physical therapy, or occupational therapy.
Monitoring and follow-up: The patient will have regular follow-up appointments with their neurosurgeon to monitor their recovery progress, address any concerns or complications, and adjust their treatment plan as needed.
What to Ask Your Doctor
What specific type of brain surgery do you recommend for my condition?
What are the potential risks and complications associated with this surgery?
What is the success rate for this type of surgery in treating my condition?
How long is the recovery time expected to be after the surgery?
What type of anesthesia will be used during the surgery?
How experienced are you in performing this type of brain surgery?
Are there any alternative treatment options to consider before undergoing surgery?
What can I expect in terms of post-operative care and follow-up appointments?
Are there any specific lifestyle changes or precautions I should take before and after the surgery?
What is the prognosis for my condition after undergoing this surgery?
Reference
Authors: Schirmer SH. Journal: Herz. 2024 Dec;49(6):479-488. doi: 10.1007/s00059-024-05274-x. Epub 2024 Oct 21. PMID: 39432064