Dr AUBREY BRISTOW - PREOPERATIVE ASSESSMENT v3
BLOOD TESTS   INVESTIGATIONS  
       
  FBC Over 60 for major surgery   Urinalysis All patients
  If significant bloodloss expected    
  Significant CVS/RS disease   ECG Over 40
  Sickle cell disease   CVS/RS disease or hypertension
  GI cancer or bleeding   Renal disease over 30
  Renal/liver failure   Digoxin/antiarrythmics/diuretics/ACE inhibitors
  Diabetes   Please give patient a copy
  Connective tissue disease  
    Echo Significant CVS disease
  U and Es Over 70   Any heart failure
  Significant CVS/RS disease   Undiagnosed murmur
  GI cancer or bleeding  
  Renal/liver failure   CXR TB
  Diuretics/ACE inhibitors/steroids   Lymphoma
    Significant CVS/RS disease
  Clotting Anticoagulants   Malignancy that can spread
  Coagulopathy   Significant connective tissue disease
  Liver failure/alcoholism  
  Haematological malignancy   Cervical XR Ankylosing spondylitis that is symptomatic/RA/OA
    Trauma
  Sickle cell Only if afrocaribean and history of sickle   need flexion/extension and open mouth odontoid peg
  Hb as well if sickle is ordered  
      Lung function  Severe RS disease
    Kyphoscoliosis
  Blood sugar Diabetes   Exercise tolerance under 100m
  Steroids  
  Large/recurrent abcesses   Peak flow adequate for controlled asthmatics
  HbAc as well if known diabetic  
    Thyroid FT Clinical hyper/hypo thyroid
  Crossmatch ONLY if expected blood loss over 20%   omit if documented in last 3/12
   
  LFTs Liver/renal failure
  Alcoholism DISEASES  
  Maliganancy that can spread  
  IV antifungal agents   CVS FBC, U&E, Creatinine, LFTs, CXR, ECG
    Clotting if anticoagulated
  Pregnancy test If patient says pregnancy possible   ABGs if significant dyspnoea or failure
      Cardiac consultation/notes if unstable
 
  RS If controlled asthmatic, just peak flow
DRUGS Diuretics U&E ECG   FBC, U&E, creatinine, CXR for uncontrolled asthma / COAD
  BP drugs U&E ECG   ABGs, Lung function tests if severe
  Digoxin U&E ECG   no elective general anaesthetic within 2 weeks of 'attack'
  Antiarrythmics U&E ECG   COADs need preadmitting unless mild
  Aminophylline U&E ECG    
  Steroids U&E creatinine LFTs FBC   Renal FBC, U&E, creatinine, LFTs, BS, CXR, ECG
  Anticoagulants Clotting FBC platelets   schedule surgery post dialysis
  IV/O antifungals LFTs    
  Thyroid TFTs, LFTs, ECG   Liver/bowel FBC, clotting, U&E, creatinine, LFTs, ECG plus CXR over 60
  Immunosuppresives FBC U&E LFTs clotting   Consider ultrasound
   
  Thyroid Thyroid function tests
  Thoracic inlet and chest X ray if significant goitre
NIL BY MOUTH     ECG if hyperthyroid
  2 hours for fluids    
  4 hours for human breast milk   CNS FBC, U&E, CXR, ECG
  6 hours for food    
    Arthritis FBC, U&E, LFTs, CXR, Cx spine
  any fluids OK except milk/fruit juice   Consider pulmonary function tests
  allow dash of milk in tea/coffee  
      Diabetes FBC, U&E, LFTs, BS, HbAc, ECG
  urge patients NOT to starve for longer   Consider chest X ray
    Pxs on insulin need converting to short acting so preadmit
 
Only use Royal College of Anaesthetists booklet   Sickle cell FBC, U&E, Creatinine, electrophoresis
Any patient can self refer to see me   give patient copy of result in all cases
   
Tel: 020 7193 3466 email: anaesthesia@unconsciousness.net
ADVICE I need to see preadmission if:
NO SMOKING WITHIN 24 HOURS OF OPERATION Pathology unstable, undiagnosed or significant
Severe asthma, COAD, dyspnoea
Angina, MI or cardiac failure
Liver or renal disease
Haemaglobinopathy, coagulopathy or anaemia
Cervical spine pathology
Diabetic on drugs
Latex allergy or anaesthetic complications