The preoperative evaluation: use the history and physical rather than routine testing.

Abstract

The history and physical examination, rather than routine laboratory, cardiovascular, and pulmonary testing, are the most important components of the preoperative evaluation. The history should include a complete review of systems (especially cardiovascular and pulmonary), medication history, allergies, surgical and anesthetic history, and functional status. s KEY POINTS Laboratory testing should be selective and justified by specific findings on the history or physical examination. Lee et al (Circulation 1999; 100:1043-1049) devised a simple index of cardiac risk based on the presence or absence of six factors: high-risk surgery, ischemic heart disease, congestive heart failure, stroke or transient ischemic attack, insulin-dependent diabetes mellitus, and serum creatinine concentration greater than 2 mg/dL. All patients at risk undergoing surgery should receive a selective beta-blocker such as metoprolol 50 mg twice daily, starting 1 week before surgery. Noninvasive cardiac stress testing is reserved for patients at uncertain or high risk.

Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

“…The ultimate goal of preoperative medical assessment is to reduce the morbidity associated with surgery and anesthesia and to increase the quality and decrease the cost of perioperative care. It also serves the purpose of optimizing patients for elective surgery and if necessary, implements measures to prepare higher risk patients for surgery [1,2].…”

“…The pre-operative anesthesia evaluation comprises of comprehensive history, physical examination and laboratory tests [1]. The history should include a complete review of systems, medication history, surgical and anesthetic history, history of allergies and functional status.…”

“…Recent literature suggests that preoperative laboratory testing should be based on clinical examination rather than routine protocols [1][2][3][4][5][6]. Preoperative hemoglobin test or screening for anemia is included in most of the hospitals preoperative testing protocols in third world countries despite the fact that routine laboratory tests for all patients are not good screening device for diseases [3].…”

“…The history should include a complete review of systems, medication history, surgical and anesthetic history, history of allergies and functional status. The physical examination and laboratory tests should be focused on information gathered from the history [1][2][3][4][5][6].…”

Haematologic Response in Hyperglycaemic Rats Experimentally Induced with Alloxan

“…This finding might be due to medullary red cell destruction (dsyerythropoiesis), in vivo destruction of megaloblastic matured red cell [18][19][20], or premature intravascular destruction of the circulating red blood cell secondary to oxidative stress [21,22] derived from increased lipid peroxidation of erythrocyte membrane.…”