You are listening to the podcast surgery. I see rounds. My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director of the Burns Center of Vanderbilt Regional Burn Center in Nashville, Tennessee.

The website that I have is www.burdoc.com. There's a variety of educational offerings there, as well as links to blogs and other podcasts that I run.

The topic that I wanted to mention that I have a discussion about today is the idea

of perioperative evaluation and management of a patient who has cardiovascular disease.

Often a patient will come into our unit and we're making rounds on the patient and I'll put the

residents through some questions almost immediately regarding anybody who's been admitted to our ICU or our floor

is that some basic understandings of what's the patient's past medical history.

And the reason why we're doing it is not that we're trying to be, you know, focus on a bunch of irrelevant minutia

that doesn't really affect the patient's outcome is that a lot of the things that we do in critical care and surgery

nowadays is trying to reduce perioperative risks of the patient. When you look at the operations

that we're doing today versus the operations we did, say, you know, 50 years ago, it would seem

that what we're doing is reasonably dramatically different. We're doing, though, very similar operations through much smaller incisions using longer instruments,

but with cameras.

But we've seen really dramatic increases in patient survival and reductions in complications.

And sometimes it seems to get lost in a lot of discussions about MRSA and the like.

But it's important to realize that what we're trying to do when we walk up to a patient preoperatively,

we identify that they need surgery.

And surgery isn't immediately life-brediting.

We have time to evaluate the patient and do some workup is we're trying to reduce the risk to that particular patient.

I'll tell the residents a lot, it's like trying to get some background information.

It's almost like we're trying to cheat on a test.

...