Transcript Perioperative Testing

PERIOPERATIVE TESTING
Question 1
• A 54 year old man is scheduled for elective inguinal hernia
repair in 2 weeks. He has a PMH of well controlled
hypertension on amlodipine. No previous surgeries. He is
able to do 4 METS of activity without chest pain or
dyspnea. His vital signs and physical exam is normal today.
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Which of the following are indicated prior to his surgery?
PT/PTT
Chest Xray
CBC
PT/PTT and CXR
None of the above
• Don’t obtain preoperative chest radiography in the absence
of a clinical suspicion for intrathoracic pathology.
• Avoid admission or preoperative chest x-rays for ambulatory
patients with unremarkable history and physical exam.
• Only 1% to 3% show a clinically significant abnormality,
however, of which only approximately 0.1% affect clinical
care. (MKSAP 16)
• Avoid routine preoperative testing for low risk surgeries
without a clinical indication.
• Findings influence management in under 3% of patients
tested.
• In almost all cases, no adverse outcomes are observed
when clinically stable patients undergo elective surgery,
irrespective of whether an abnormal test is identified.
Question 2
• MKSAP 16 question 125
• Don’t perform preoperative medical tests for
eye surgery unless there are specific medical
indications.
• Low risk surgeries that don’t require cardiac
screening
Endoscopic surgery
Cataract surgery
Superficial surgery
Breast surgery
Ambulatory surgery
Question 3
• MKSAP 16 question 47
• The only therapy proved effective for reducing the risk of
postoperative pulmonary complications in the immediate
perioperative period is pre- and postoperative lung volume
expansion.
• Results of pulmonary function testing do not predict the risk
of pulmonary complications, and these tests have no role in
routine preoperative evaluation.
MKSAP 16
Question 4
• MKSAP 16 question 149
4. A 70-year-old man is evaluated preoperatively before elective total
hip arthroplasty. He is able to ambulate on a level surface slowly but is
unable to carry laundry or groceries up stairs because of his hip pain. He
has had no recent chest pain or pressure. He has no orthopnea. Other
than his hip pain, he feels well. He has hypertension and hyperlipidemia.
Current medications are metoprolol, losartan, and simvastatin.
BP is 132/78, HR 64, and RR 14/min. PE is normal. Serum creatinine level
is 1.3 mg/dL. An electrocardiogram shows sinus rhythm with no ST- or Twave abnormalities.
Which of the following is the most appropriate diagnostic test to
perform next?
A.
B.
C.
D.
Cardiac Cath
CT coronary angiography
Dobutamine Stress Echo
No further testing needed
Patients who have no cardiac history and
good functional status do not require
preoperative stress testing prior to noncardiac thoracic surgery.
MKSAP 16
(1) history of heart disease, (2) history of compensated or prior heart failure, (3) history of
cerebrovascular disease, (4) kidney insufficiency, (5) diabetes mellitus.
Perioperative Medicine
• Preoperative imaging and laboratory tests should be ordered
only when an abnormal result is suspected on the basis of
known or suspected comorbidities and when such a result
would alter management.
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For example,
– UPT in young women
– Cervical spine radiographs in rheumatoid arthritis
– Creatinine in chronic kidney disease
– Potassium level in patients taking diuretics.
– In each case, the test is performed to evaluate for evidence of a condition that
can have a silent presentation or assess an important physiologic variable
likely to be abnormal.
MKSAP 16