Pre-op Testing

Question 1

Goals of a Preoperative Evaluation

Answer 1

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

Question 2

What tests should be ordered?

Answer 2

Hospital requirements

Patient history & risk of procedure

Question 3

When can you use past lab tests for surgery?

Answer 3

Normal within past 4 months unless there has been a change in clinical status

Question 4

When is an H&H indicated?

Answer 4

Major surgery if >65

Younger patients if significant blood loss is expected

Question 5

When is a creatinine indicated?

Answer 5

50+ with intermediate or high risk surgery

Younger with anticipated hypotension or nephrotoxic drugs

Question 6

When is a pregnancy test indicated?

Answer 6

All women of reproductive age

Question 7

When should a CXR & PFTs needed?

Answer 7

50+ with upper abdominal or thoracic surgery

Question 8

When is a CBC warranted?

Answer 8

Age 65+ having major surgery

H&H where major blood loss expected

Question 9

At what level of a serum creatinine is there an increased cardiac risk?

Answer 9

> 2 mg/dL

Question 10

When is a creatinine indicated?

Answer 10

50+ with:
Moderate surgery risk
Anticipated hypotension
Possible use of nephrotoxic drugs

Question 11

When is a CMP recommended?

Answer 11

Patient on:
Diuretics
ACEI
ARB
Known renal disease

Question 12

What type of diabetes is at greater risk of cardiac complications?

Answer 12

Insulin-dependent DM

Question 13

Which patients have a greater morbidity & mortality in regards to LFTs?

Answer 13

Cirrhosis

Acute liver failure

Question 14

When are bleeding tests required?

Answer 14

Anti coagulated patients

Neurosurgery

Question 15

When is a UA indicated?

Answer 15

Never

Question 16

When is a pregnancy test indicated?

Answer 16

Women of reproductive age

Question 17

A patient with what conditions require an EKG?

Answer 17

CAD
CHF
Arrhythmias
Structural HD
PAD or cerebrovascular disease
DM

Question 18

Lee Index

Answer 18

High risk surgery
History of ischemic HD
HF
Cerebrovascular disease
Insulin dependent DM
Creatinine >2

Question 19

Recommend a CXR for Patients with

Answer 19

Known/suspected
cardiopulmonary disease
50+ undergoing AAA or upper abdominal/thoracic surgery

Question 20

Consider a CXR for Patients

Answer 20

AP & lateral for the morbidly obese (BMI >40)

70+ without risk factors

Question 21

When are PFT’s recommended?

Answer 21

Lung resection
Unexplained dyspnea or exercise intolerance
COPD or asthma

Question 22

Pulmonary Complications with Surgery

Answer 22

COPD
CHF
OSA
Pulmonary HTN
50+

Question 23

Which patients need a sleep study prior to surgery?

Answer 23

Patients with persistent symptoms, don’t follow treatment plan, & have had weight changes

Question 24

Smoking & Surgery

Answer 24

Less likely to heal fusions & skin grafts

Check serum continine levels: normal after 2 weeks of abstinence

Question 25

Immunocompromised Patients & Surgery

Answer 25

Less likely to heal

More likely to develop an infection