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Invited commentary

College of Surgeons of Sri Lanka
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for pdf 2011 December SLJS.cdr Invited commentary This review article provides a comprehensive overview of the emerging and established trends in pre-operative management of patients for major cancer surgical procedures. These optimization procedures would, in my opinion, be applicable to any patient undergoing major surgery. This commentary is on how these strategies are applicable to patients undergoing major and cancer surgery in Sri Lanka. Pre operative risk assessment undoubtedly plays an important role in patient management. This allows for detection of risk factors, optimizing the patient, planning the anaesthetic and surgery and providing necessary information to the patient. In our setting, this mostly happens following admission to hospital, leaving little time for maximum optimization processes to occur. Establishment of Pre-operative Anaesthesia Clinics (PAC) is often a consideration in anaesthesia departments in major hospitals. The lack of trained personnel has prevented their existence. Increase in the number of trained anaesthetists who can be spared from theatre and intensive care duties would help us in establishing and sustaining PAC's in the future. Undoubtedly, these clinics would help in early detection of co-morbid risks and allow time for optimization prior to surgery. We are limited by the non availability of dynamic tests for assessment of physiologic capacity or fitness levels in our patients. We use only static tests like 2- dimensional echocardiography, lung function tests and blood gas analysis for assessment of cardio p u l m o n a r y s t a t u s . D o b u t a m i n e s t r e s s echocardiography is limitedly available in some centers. It is well established that reduced physiologic capacity leads to poor outcomes following major surgery. We lack the facility of the gold standard Cardio-Pulmonary Exercise testing (CPET) in Sri Lanka which would be an investment well worth. Not only wo

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