Our Summary

This research paper talks about the major issues related to heart problems that can occur before, during, or after surgery. It advises that before any operation, patients should be thoroughly checked for potential heart risks. There are specific calculators that doctors can use which take into account the patient’s specific health condition and the type of operation being performed. American and European guidelines suggest performing stress tests when needed based on these assessments.

The Canadian approach is slightly different, prioritizing cost-effectiveness. They recommend a test that measures certain chemicals in the brain related to heart function (known as brain natriuretic peptide or N-terminal prohormone of brain natriuretic peptide) to help identify any potential heart damage after surgery.

The paper suggests that if a patient has specific heart conditions like acute coronary syndrome, severe pulmonary hypertension, or decompensated heart failure, non-emergency surgeries should be delayed until these conditions are properly handled.

Lastly, the research highlights that there’s an ongoing discussion about the role of biomarkers (specific molecules that can indicate a disease) and heart damage after non-heart-related surgeries to better assess the risk involved. However, it’s still unclear how effective these strategies are in guiding medical interventions.

FAQs

  1. What are the recommended guidelines for preoperative risk assessment and postoperative monitoring of at-risk patients?
  2. How do Canadian guidelines differ from American and European guidelines in terms of postoperative screening for myocardial injury or infarction?
  3. What conditions should lead to the postponement of nonemergent surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about brain surgery is to follow all preoperative instructions carefully, such as fasting before surgery and avoiding certain medications. It is also important to discuss any concerns or questions with your healthcare team and to follow all postoperative care instructions to aid in the recovery process. Additionally, it is important to attend all follow-up appointments and rehabilitation sessions as recommended by your healthcare provider.

Suitable For

Patients who are typically recommended for brain surgery include those with brain tumors, traumatic brain injuries, epilepsy that cannot be controlled with medication, arteriovenous malformations, hydrocephalus, and certain types of movement disorders (such as Parkinson’s disease). Patients with these conditions may benefit from brain surgery to alleviate symptoms, improve quality of life, or potentially cure the underlying condition. Additionally, patients with certain types of brain tumors or other conditions that are causing increased pressure within the skull may require urgent or emergent brain surgery to prevent further complications or damage.

Timeline

Before brain surgery:

  1. Consultation with a neurosurgeon: The patient meets with a neurosurgeon to discuss the reasons for surgery, potential risks and benefits, and what to expect during and after the procedure.

  2. Preoperative testing: The patient may undergo various tests such as MRI scans, CT scans, blood tests, and electroencephalograms to assess their overall health and determine the best course of action for surgery.

  3. Anesthesia evaluation: The patient meets with an anesthesiologist to discuss their medical history, medications, and any allergies to anesthesia. A plan for anesthesia during surgery is developed.

  4. Preoperative instructions: The patient receives instructions on how to prepare for surgery, such as fasting before the procedure and stopping certain medications.

After brain surgery:

  1. Immediate postoperative care: The patient is closely monitored in the recovery room for any complications such as bleeding, infection, or changes in neurological status. Pain management and wound care are also provided.

  2. Hospital stay: Depending on the type of surgery performed, the patient may need to stay in the hospital for a few days to a week for further monitoring and rehabilitation.

  3. Follow-up appointments: The patient will have follow-up appointments with the neurosurgeon to assess their recovery, remove any stitches or staples, and discuss any ongoing symptoms or concerns.

  4. Rehabilitation: Depending on the extent of the surgery and the patient’s condition, they may require physical therapy, occupational therapy, or speech therapy to help regain function and improve quality of life.

Overall, the timeline of a patient’s experience before and after brain surgery can vary depending on the type of surgery performed and the individual patient’s health status and recovery process.

What to Ask Your Doctor

  1. What specific type of brain surgery will I be undergoing?
  2. What are the potential risks and complications associated with this type of brain surgery?
  3. What is the expected recovery time and rehabilitation process after the surgery?
  4. How often will I need follow-up appointments after the surgery?
  5. Will I need any additional tests or evaluations before the surgery?
  6. What are the potential long-term effects or complications of the brain surgery?
  7. What is the success rate of this type of brain surgery for my condition?
  8. Are there any alternative treatment options to consider before undergoing brain surgery?
  9. What is the experience and success rate of the surgical team performing the brain surgery?
  10. How can I best prepare myself physically and mentally for the brain surgery?

Reference

Authors: Raslau D, Bierle DM, Stephenson CR, Mikhail MA, Kebede EB, Mauck KF. Journal: Mayo Clin Proc. 2020 May;95(5):1064-1079. doi: 10.1016/j.mayocp.2019.08.013. Epub 2020 Feb 24. PMID: 32107033