The physiological profile of the high -risk patient.

All general anesthesia produce a depression of the myocardial functionand all surgical operations represent a traumatic event, albeitplanned and controlled. The physiologic rehabilitation that followsgeneral anesthesia and a major operation is conditioned by the humanbody’s capacity to mobilize its cardiac, respiratory and met abolicreserves. Since these reserves are often in short supply to thehigh risk patient, especially the elderly, it is important for the surgeonand the anesthesiologist to be able to explore the base state ofthe physiological functions that assure survival in a given patient.The method used to assess this base state must then permit to correctin an optimal fashion whatever physiological deficits werefound, by preference preoperatively, and allow the continuation ofthis guided recovery intra-and postoperatively.In order to assure the best possible result of critical care and treat -ment, be it operative or non-operative (often confusingly called“medical or conservative”), we have used a computer program forthe past 40 years called “Automated Physiological Profile”. Thisprogram allows the rapid assembly of base line values obtainedthrough Swan- Ganz right cardiac catheterization and the equallyrapid calculation of a whole array of physiological values, derivedfrom the initial base line. The results are printed on a sheet feat uringthe graphics of the corresponding normal values. The observeddifferences guide the treatment and make a physiological compensationof noted deficiencies possible. Besides demonstrating theutility of this system for the care of high risk patients, we will alsoallude to its use in patients with cardiac pump failure, pulmonarythromboembolism, septicemia and shock from hemorrhage.