Preoperative Evaluation of Patients With Neurological Disease

Kathrin Lieb, MD; Magdy H. Selim, MD, PhD


Semin Neurol. 2008;28(5):603-610. 

In This Article

General Preoperative Measures

Any respiratory infection should be treated prior to surgery to minimize postoperative pulmonary complications. Premedication with H2-receptor blockers for patients at risk of aspiration due to gastroesophageal reflux disease, and ß-blockers in patients with cardiac disease is advised.[23,24,25,26] The use of long-acting sedatives should be avoided, whenever possible, to facilitate assessment of neurological status throughout the perioperative period. Neurological patients, particularly those with stroke, spinal injury, and brain tumors, are at increased risk for developing deep vein thrombosis (DVT)[27] due to prolonged immobility, leg weakness, and secondary hypercoagulability states.[28] It is important to start DVT prophylaxis preoperatively and continue until the patient is mobilized after the surgery. Perioperative use of subcutaneous or low-molecular weight heparin and/or intermittent pneumatic pressure is advised. Severely malnourished patients and patients without food intake for more than 3 days prior to surgery should receive preoperative nutritional supplementation.[19,29] It is important to correct dehydration preoperatively, especially in patients taking diuretics or edema-lowering agents such as mannitol or hypertonic saline, to maintain adequate cerebral perfusion during the perioperative period. An important, yet often understated, aspect of preoperative evaluation is to provide patients with information about their planned surgery, possible complications, and their individual risk factors for perioperative complications. This should include discussing strategies for risk reduction, such as the importance of blood pressure and glycemic control, and compliance with medications. Patients should be encouraged to stop smoking preoperatively. Smoking cessation is an important overall health intervention, and surgery could provide the impetus for the patient to quit. There is some evidence to suggest that smoking cessation before surgery may minimize perioperative pulmonary complications and improve wound healing.[30] Patients are likely to benefit from preoperative knowledge of their risk stratification and be more compliant with suggested preoperative instructions.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: