Question

A patient who was posted for elective inguinal hernia surgery has history MI for which he underwent CABG. What will you do in pre operative assessment?

• A. History + c/e + routine labs + angiography to look for stent patency
• B. History + c/e + routine labs
• C. History + c/e + routine labs + stress test
• D. History +c/e + routine labs + V/Q scan

Answer 1

The Correct Option is C

When preparing a patient for elective inguinal hernia surgery, particularly with a history of myocardial infarction (MI) and subsequent coronary artery bypass grafting (CABG), a thorough preoperative assessment is crucial to mitigate risks associated with anesthesia and surgery. The following steps outline an appropriate preoperative assessment strategy:

1. History: Conduct a comprehensive clinical history review. This includes the patient's cardiac history (details of the MI, any symptoms such as chest pain or dyspnea, details about the CABG procedure), and an assessment of the patient’s recovery and current cardiac status.
2. Clinical Examination (c/e): Perform a complete physical examination focusing on the cardiovascular system. Look for signs of heart failure or ischemic heart disease and evaluate the patient’s functional capacity.
3. Routine Lab Tests: Obtain pertinent laboratory tests such as complete blood count, electrolytes, renal function tests, and coagulation profile. These are necessary to understand the patient’s baseline health status and any possible complications.
4. Stress Test: Given the cardiac history, performing a stress test will help evaluate the current functional status of the heart and assess the risk of perioperative cardiac complications. This test can identify possible ischemic changes during increased cardiac demand, which is crucial for surgical planning.

Choosing to include a stress test is particularly important in this scenario due to the patient's history of significant cardiac intervention, ensuring a comprehensive assessment allows for an informed and safe approach to their surgical care.