What preoperative evaluations and optimizations are needed for a 53-year-old female with hyperlipidemia and prediabetes undergoing eye surgery under Monitored Anesthesia Care (MAC) anesthesia?

From the Guidelines

For a 53-year-old female with hyperlipidemia and prediabetes undergoing eye surgery under MAC anesthesia, a comprehensive preoperative evaluation and optimization plan should be implemented to minimize perioperative risks and ensure the best possible outcomes in terms of morbidity, mortality, and quality of life. To achieve this, several key steps should be taken:

• A thorough medical history and medication review should be conducted to identify any potential risks or interactions, particularly focusing on her hyperlipidemia and prediabetes management 1.
• Basic laboratory tests, including a basic metabolic panel and fasting lipid profile within 3 months of surgery, are essential for assessing her current metabolic state 1.
• Blood glucose levels should be assessed preoperatively, aiming for a target of less than 180 mg/dL; if elevated, consideration should be given to delaying elective surgery until better control is achieved 1.
• The patient should continue her lipid-lowering medications, such as statins, without interruption through the perioperative period 1.
• Given her prediabetes status, it's crucial to manage her blood glucose levels perioperatively; metformin should be held on the day of surgery, and other oral glucose-lowering agents should be managed according to the latest guidelines 1.
• A cardiovascular assessment, including blood pressure measurement and ECG if indicated by risk factors, is necessary to evaluate her cardiac risk 1.
• Airway evaluation is also important, even for MAC cases, due to the potential need for conversion to general anesthesia 1.
• The patient should be instructed to fast for 6 hours from solid food and 2 hours from clear liquids before surgery and to take her regular medications on the morning of surgery with a small sip of water, except for any oral hypoglycemic agents which should be held 1. By following these guidelines and considering the patient's specific health conditions, the risk of perioperative complications can be minimized, and the best possible outcomes in terms of morbidity, mortality, and quality of life can be achieved 1.

From the FDA Drug Label

Surgery and other procedures —Withholding of food and fluids during surgical or other procedures may increase the risk for volume depletion, hypotension, and renal impairment. Metformin hydrochloride tablets should be temporarily discontinued while patients have restricted food and fluid intake

The patient is undergoing eye surgery under Monitored Anesthesia Care (MAC) anesthesia. Preoperative evaluations and optimizations needed for this patient include:

• Assessment of renal function, as metformin is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m^2
• Temporary discontinuation of metformin hydrochloride tablets while the patient has restricted food and fluid intake
• Monitoring for signs of lactic acidosis, hypoglycemia, and other potential complications
• Evaluation of the patient's hyperlipidemia and prediabetes to ensure that they are stable and well-managed before proceeding with surgery
• Consideration of the patient's vital signs and overall health status to ensure that they are stable enough for surgery

To proceed with clearance risk certification, the following steps should be taken:

• Obtain an estimated glomerular filtration rate (eGFR) to assess renal function
• Temporarily discontinue metformin hydrochloride tablets while the patient has restricted food and fluid intake
• Monitor the patient closely for signs of complications and adjust the treatment plan as needed
• Ensure that the patient's hyperlipidemia and prediabetes are well-managed and stable before proceeding with surgery 2 2

From the Research

Preoperative Evaluations and Optimizations

For a 53-year-old female with hyperlipidemia and prediabetes undergoing eye surgery under Monitored Anesthesia Care (MAC) anesthesia, the following preoperative evaluations and optimizations are needed:

• A thorough medical history and physical examination to assess the patient's overall health and identify any potential risks or complications 3
• Evaluation of the patient's hyperlipidemia and prediabetes, including review of current medications and laboratory results 4
• Assessment of the patient's airway and respiratory status, as well as any potential risks for difficult intubation or ventilation 5
• Review of the patient's current weight loss medications and any prior weight loss surgeries, if applicable 6

Laboratory Tests and Evaluations

The following laboratory tests and evaluations may be necessary for this patient:

• Complete blood count (CBC)
• Basic metabolic panel (BMP)
• Liver function tests (LFTs)
• Lipid profile, including triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) 7
• Fasting blood glucose and hemoglobin A1c (HbA1c) to assess glycemic control
• Electrocardiogram (ECG) to assess cardiac function

Risk Certification and Clearance

To proceed with the clearance and risk certification, the following steps should be taken:

• The patient's primary care physician and anesthesiologist should be consulted to discuss the patient's medical history, current medications, and any potential risks or complications 4, 3
• The patient should be evaluated for any potential risks or complications related to her hyperlipidemia and prediabetes, such as cardiovascular disease or respiratory complications 7, 5
• The patient's airway and respiratory status should be assessed, and any potential risks for difficult intubation or ventilation should be identified and addressed 5
• The patient should be cleared for surgery by her primary care physician and anesthesiologist, and any necessary precautions or modifications to the anesthesia plan should be made 6, 3