17: Preoperative Evaluation

CHAPTER 17 Preoperative Evaluation

7 What are the appropriate preoperative laboratory tests? Which patients should have an electrocardiogram? Chest radiography?

No evidence supports the use of routine laboratory testing. Rather, there is support for the use of selected laboratory analysis based on the patient’s preoperative history, physical examination, and proposed surgical procedure (Table 17-2). Unless there has been an intervening change in status, electrocardiogram and chest radiograph obtained within 6 months of the procedure need not be repeated. Likewise, chemistries and hemoglobin/hematocrit values obtained within 1 month are acceptable in the stable situations. Coagulation studies should be no more than 1 week old.

TABLE 17-2 Appropriate Preoperative Laboratory Tests Based on Patient History and Physical Examination*

Test Indications
Electrocardiogram Cardiac and circulatory disease, respiratory disease, advanced age
Chest radiograph Chronic lung disease, history of congestive heart disease
Pulmonary function tests Reactive airway disease, chronic lung disease, restrictive lung disease
Hemoglobin/hematocrit Advanced age, anemia, bleeding disorders, other hematologic disorders
Coagulation studies Bleeding disorders, liver dysfunction, anticoagulants
Serum chemistries Endocrine disorders, medications, renal dysfunction
Pregnancy test Uncertain pregnancy history, history suggestive of current pregnancy

The definition of advanced age is vague and should be considered in the context of that patient’s overall health.

* At least 50% of the task force experts agreed that the listed tests were beneficial when used selectively. Because of a lack of solid evidence in the literature, these indications are somewhat broad and vague and limit the clinical use of the guidelines.

May 31, 2016 | Posted by in ANESTHESIA | Comments Off on 17: Preoperative Evaluation
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