Pre-operative assessmentPre-operative assessmentprior Laparoscopic Surgeryprior Laparoscopic Surgery

PresenterPresenterDr. Tanmoy Roy M.DDr. Tanmoy Roy M.D

Anaesthesiologist & Intensive Care practitionerAnaesthesiologist & Intensive Care practitionerSwagat Endolaparoscopic Surgical Research InstituteSwagat Endolaparoscopic Surgical Research Institute

GuwahatiGuwahati

Pre-operative interaction, patient history & physical examination

(Review any relevant, valid previous available record)

Pre-operative laboratory and imaging investigations

Routine Indicated

Why do it ???

• Familiarize with the patient

• To help formulate or modify anesthetic care of the patient

• To identify or verify a condition which could affect anesthetic care

• Can the identified risk be mitigated?• Cardiac• Pulmonary• Drugs• Bleeding, clotting, and bridging• DM

• Other (liver, kidneys, endocrine)

Anesthesiology 2012 (ASA Practice Advisory for Pre-anesthesia Evaluation)

When to examine???“In scheduled and elective cases ideally an initial pre operative assessment should be performed immediately following the decision to operate”

•Timing of examination depends on the surgical invasiveness and presence of co-morbidities

a)High surgical invasiveness- before day of Sxb)Medium surgical invasiveness- before day of Sxc)Low surgical invasiveness- before or on day of Sx

•Presence of co-morbidities indicate examination on a prior basis

Is Pre-operative Testing a Problem ????

Yes, and a big one• It wastes valuable resources• It exposes patients to needless blood work and

procedures• It can create anxiety for patients• It is costly…$30 billion/year (1987 $)

Katz, Anesth Analg 2011 Roizen, Anesthesiol Clin North Am 1987

To do or not to do ???

NICE Guidelines….The National Institute for Clinical Excellence (NICE) Guideline in June 2003 for professionals who order routine tests:

•Plain chest X-ray.•Twelve lead resting ECG.•Full blood count.•Haemostasis-PT, aPTT •Serum urea, creatinine, and electrolytes.•Random serum glucose.•Urine analysis.•Blood gases.•Lung function test.•Pregnancy test, if history is significant.•Sickle cell haemoglobin test and other Hb-pathies.

How Do You Decide?

• My last case ride (……that crash-landed…)

• What my chief resident told me to do

• Evidence Based Medicine, EBM

• Guidelines…which ones?

Duration of test validity ???

Preoperative Fasting ???

Rule of….

Clear, non-particulate fluids

Breast milk Solid food, Infant formula

Other milk

THEREFORE…“Preoperative examination is a must to know your patient’s physiology. In the least, examination covering the pulmonary system, the cardiovascular system and the renal system is essential”

“Preoperative testing should be dictated by the patient’s clinical condition, abnormal findings on history or exam and the suspected physiological changes involved in the surgical procedure”

“A preoperative test is NOT INDICATED unless there is a specific reason to perform the test and the result will change management, or mitigate perioperative risk”

Thank You AllFor Listening