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