Pre-op Testing Flashcards
Goals of a Preoperative Evaluation
Define co-morbidities
Evaluate severity & stability of co-morbidities
Identify unrecognized comorbid disease
Identify risk factors for medical complications of surgery
Optimize all medical conditions
Recommend perioperative measures to reduce risk
What tests should be ordered?
Hospital requirements
Patient history & risk of procedure
When can you use past lab tests for surgery?
Normal within past 4 months unless there has been a change in clinical status
When is an H&H indicated?
Major surgery if >65
Younger patients if significant blood loss is expected
When is a creatinine indicated?
50+ with intermediate or high risk surgery
Younger with anticipated hypotension or nephrotoxic drugs
When is a pregnancy test indicated?
All women of reproductive age
When should a CXR & PFTs needed?
50+ with upper abdominal or thoracic surgery
When is a CBC warranted?
Age 65+ having major surgery
H&H where major blood loss expected
At what level of a serum creatinine is there an increased cardiac risk?
> 2 mg/dL
When is a creatinine indicated?
50+ with:
Moderate surgery risk
Anticipated hypotension
Possible use of nephrotoxic drugs
When is a CMP recommended?
Patient on: Diuretics ACEI ARB Known renal disease
What type of diabetes is at greater risk of cardiac complications?
Insulin-dependent DM
Which patients have a greater morbidity & mortality in regards to LFTs?
Cirrhosis
Acute liver failure
When are bleeding tests required?
Anti coagulated patients
Neurosurgery
When is a UA indicated?
Never
When is a pregnancy test indicated?
Women of reproductive age
A patient with what conditions require an EKG?
CAD CHF Arrhythmias Structural HD PAD or cerebrovascular disease DM
Lee Index
High risk surgery History of ischemic HD HF Cerebrovascular disease Insulin dependent DM Creatinine >2
Recommend a CXR for Patients with
Known/suspected
cardiopulmonary disease
50+ undergoing AAA or upper abdominal/thoracic surgery
Consider a CXR for Patients
AP & lateral for the morbidly obese (BMI >40)
70+ without risk factors
When are PFT’s recommended?
Lung resection
Unexplained dyspnea or exercise intolerance
COPD or asthma
Pulmonary Complications with Surgery
COPD CHF OSA Pulmonary HTN 50+
Which patients need a sleep study prior to surgery?
Patients with persistent symptoms, don’t follow treatment plan, & have had weight changes
Smoking & Surgery
Less likely to heal fusions & skin grafts
Check serum continine levels: normal after 2 weeks of abstinence
Immunocompromised Patients & Surgery
Less likely to heal
More likely to develop an infection
