Anasthesiol Intensivmed Notfallmed Schmerzther. 2017 Jun;52(6):446-462. doi: 10.1055/s-0043-111784. Epub 2017 Jun 2.
Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anaesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anaesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate recommendations on the preoperative evaluation of adult patients prior to elective, non-cardio-thoracic surgery, which have been initially published in 2010. These recommendations have now been updated based on the current literature and existing international guidelines. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.
评估患者的病史和进行体格检查是择期手术前风险评估的基石，有助于优化患者的术前医疗状况并指导围手术期管理。额外的技术检查（如血液生化、心电图、肺活量测定、胸部X光）是否有助于降低围手术期风险，往往不太为人所知或存在争议。同样，麻醉医生、内科医生和外科医生在患者长期用药的围手术期管理方面也存在很大的不确定性。因此，德国麻醉学与重症医学科学协会（DGAI）、内科学会（DGIM）和外科学会（DGCH）联合制定了关于成人患者择期非心胸外科手术术前评估的建议，该建议于2010年首次发布。现在已根据当前文献和现有国际指南对这些建议进行了更新。第一部分描述了术前评估的一般原则（A部分）。B部分介绍了对已知或疑似患有重大心血管疾病患者进行扩展评估的当前概念。最后，讨论了患者长期用药的围手术期管理（C部分）。这些由DGAI、DGIM和DGCH认可的跨学科建议中提出的概念为结构化的术前风险评估和管理提供了共同基础。这些建议旨在确保手术患者接受合理的术前评估，同时避免不必要的、昂贵的和潜在危险的检查。联合建议反映了当前的最新知识以及专家意见，因为并非总是能获得基于科学的证据。当有新的经过验证的证据可用时，这些建议将定期重新评估和更新。
