Electrocardiography: the ECG

This article examines the role of electrocardiography in patient monitoring during an operative procedure. In addition to providing a wealth of physiological information, including information on the electrical activity of the heart, the ECG assists in monitoring and detecting a variety of changes, such as cardiac arrhythmias, electrolyte changes, and ischemia. Information presented on an ECG should be analyzed systematically with an understanding of the constituent elements of an ECG, the rate, the rhythm, the morphology, the axis, the presence of conduction abnormalities, electrolyte changes, and ischemic changes. To assess accurately the information presented, hemodynamic information and cardiac-risk analysis should be integrated to have a complete picture.

Age associated issues: geriatrics

The effects of aging on the body are numerous, but the most important point with regard to surgery is to differentiate the effects of aging from those of the pathology associated with a disease process that may also be present in the elderly patient. Studies tend to validate the premise that there are no labs mandated solely because of a patient's age. Rather, the physician should analyze the geriatric patient with reference to the nature of the surgery emergent versus elective; the degree of risk for the surgical procedure itself-that is high-risk, intermediate--risk, or low-risk surgery; while bearing in mind the patient's overall physiologic state. In assessing a patient's overall physiologic state an organ systems based approach focusing on the cardiac, respiratory, renal, hepatic, endocrine, nutritional, and neurologic systems may be warranted and beneficial. In the elderly population one of the key predictors of perioperative complications seems to be the geriatric patient's preoperative condition and preoperative level of functioning.