The team at Essex CPEX, Dr Chris Wright, Dr Ronan Fenton and Dr Ben Maddison are all Consultant Anaesthetists who run pre-op assessment clinics and lead CPET medicine at Broomfield Hospital, Chelmsford.
Pre-operative assessment allows a decision on suitability for the proposed procedure to be made; a decision which is made entirely by anaesthetists. It allows identification of potential anaesthetic difficulties, optimisation of pre-existing medical conditions, quantification of mortality and risk and an opportunity to formulate a plan for operative care. Increasingly this involves anaesthetists working dedicated sessions in a pre-assessment clinic, a role carried out by all the members of the team at Essex CPEX. Routine investigations such as clinical examination, ECG and blood tests are now being supplemented with more detailed physiological testing using CPET, in patients with multiple medical problems or those having high risk surgery.
Any patients having these procedures, or with the following medical problems should be considered for a CPET
High Risk Surgery
- Vascular – aneurysm repair, bypass surgery
- Colorectal – bowel resection
- Upper GI – Oeseophagogastrectomy
- Urology – Cystectomy, nephrectomy
- Head & Neck – Cancer resection
- Orthopaedic – Revision of replacement joints
Patient Risk Factors
- Heart disease – previous heart attack or angina
- Lung disease – Chronic Obstructive Pulmonary Disease (COPD)
- Kidney disease
- Previous Stroke
- Obesity – BMI>35
- Age >80
The information gathered from the CPET allows appropriate planning of the proposed surgery and gives some indication of risk in particular patient and surgical groups (references)
Carlisle J, Swart M. Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br J Surg 2007;94(8):966-9.
Older P, Hall A, Hader R. Cardiopulmonary exercise testing as a screening test for preoperative management of major surgery in the elderly. Chest 1999;116(2):355-62.
Older P, Smith R, Courtney P, Hone R. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest 1993;104(3):701-4.