KEY POINTS

1. The history and physical examination most accurately predicts the risks and the likelihood of changes in monitoring or therapy.
2. For diabetic patients, end-organ dysfunction and the degree of glucose control in the perioperative and periprocedural periods are the critical issues with regard to risk.
3. The key to managing blood glucose levels in diabetic patients perioperatively is to set clear goals and then monitor blood glucose levels frequently enough to adjust therapy to achieve these goals.
4. Obesity is associated with multiple comorbidities, including diabetes, hyperlipidemia, and chololithiasis, but the primary concern is derangements of the cardiopulmonary system.
5. Obstructive sleep apnea is important to recognize because of the increased sensitivity to and the consequence of depressing the effects of hypnotics and opioids on airway muscle tone and respiration, as well as the difficulty with laryngoscopy and mask ventilation.
6. Although no controlled, randomized prospective clinical studies have been performed to evaluate the use of adrenogenic receptor blocking drugs in patients undergoing pheochromocytoma, the preoperative use of such drugs is generally recommended before surgery.

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7. For patients with hypertension, we recommend the routine administration of all drugs preoperatively except angiotensin-converting enzyme inhibitors and angiotensin II antagonists.
8. Evaluation of a patient with cardiovascular disease depends on the clinical risk factors, extent of surgery, and exercise tolerance.
9. In patients with pulmonary disease, the following should be assessed: dyspnea, coughing and production of sputum, recent respiratory infection, hemoptysis, wheezing, previous pulmonary complications, smoking history, and physical findings.
10. In patients with pulmonary disease, several strategies, including cessation of smoking 8 weeks or more before surgery, have been suggested.
11. Risk factors for perioperative renal dysfunction include advanced age, congestive heart failure, previous myocardial revascularization, diabetes, and elevated baseline creatinine.
12. The main concern for a patient with renal disease is making it worse and thereby increasing the chance of renal failure, coma, and death.
13. Mild perioperative anemia may be significant only in patients with ischemic heart disease.
14. Careful management of chronic drug administration can include questions about the effects and side effects of alternative as well as prescription drugs.