Are Preoperative Routine Laboratory Tests Necessary in Minor and Moderate Surgical Procedures?

Yıl 2008, Cilt: 35 Sayı: 2, 120 - 127, 01.06.2008

Abit Toker Nermin Kelebek Girgin Gürkan Türker Oya Kutlay

Öz

Preoperative routine tests are commonly used to evaluate patients who will have planned elective surgical procedure. In this study, we aimed to identify the preoperative tests required for ASA I-II patients, over 40 years old, who will undergo elective minor and moderate surgeries. Totally 140 patients were included in the study. They were separated into 2 groups equally [Group I (40-59 years) and Group II (≥60 years)] according to their ages. The patients\' preoperative tests; including chest radiography, electrocardiography, hemoglobin, white blood cell, platelets, glucose, sodium, potassium, aspartate transaminase, alanine transaminase, ürea and creatinine were evaluated together with history and physical examination. After routine monitoring, balance anaesthesia was performed. The patients were followed during the peroperative and postoperative 24 hours for any problems occurred. In Group I; excluding ürea in both male and female patients and haemoglobin in only female patients; preoperative tests had no effect on the management of the asymptomatic patients. In Group II; electrocardiography, chest radiography, ürea, glucose and hemoglobin tests effected the management of the patients in the preoperative and postoperative period. In conclusion, preoperative tests could be ordered according to history and physical examination of the patients.

Anahtar Kelimeler

Minor and Moderate Surgery, ASA I-II, Preoperative Testing.

Küçük ve Orta Cerrahi Girişimlerde Preoperatif Rutin Laboratuar Testleri Gerekli midir?

Öz

Elektif cerrahi girişim planlanan olguların değerlendirilmesinde preoperatif laboratuar testleri yaygın olarak kullanılmaktadır. Çalışmamızda, ASA I-II grubu, elektif küçük ve orta cerrahi girişim planlanan, 40 yaş üstü olgularda preoperatif testlerin gerekliliğini belirlemeyi amaçladık. Kırk yaş üstü, ASA I-II grubu, küçük ve orta cerrahi girişim planlanan, 140 olgu çalışmaya alındı. Olgular 40-59 yaş (Grup I) ile 60 yaş ve üzeri (Grup II) olarak iki eşit gruba ayrıldı. Olguların akciğer radyografisi, elektrokardiografi, hemoglobin, lökosit, trombosit, kan şekeri, sodyum, potasyum, aspartat transaminaz, alanin transaminaz, üre ve kreatinin sonuçları incelendi. Öykü ve fizik muayeneleri değerlendirildi. Balans anestezi uygulanan olgular, peroperatif dönemde ve postoperatif 24 saat takip edilerek, karşılaşılan sorunlar kaydedildi. Grup I\'de üre ve kadın olgularda hemoglobin dışındaki testlerin, Grup II\'de ise elektrokardiografi, akciğer radyografisi, üre, kan şekeri ve hemoglobin sonuçlarının peroperatif ve postoperatif dönemde hastaya yaklaşımı etkilediği saptandı. Preoperatif tetkiklerin, hasta öykü ve fizik muayene bulgularına göre selektif olarak istenebileceği sonucuna varıldı.

Anahtar Kelimeler

Küçük ve Orta Cerrahi, ASA I-II, Preoperatif Test

Kaynakça

• Roizen MF, Foss JF, Ficsher SP. Preoperative evaluation. In: Miller RD (ed). 1103-1106. Anesthesia. 5th edition. Churchill Livingstone, noncardiac surgery. Am J Cardiol 2006; 97: 2000; 824-883. electrocardiography in patients undergoing
• Finegan BA, Rashiq S, McAlister FA, Prognostic value of routine preoperative O’Connor P. Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests. Can J Anaesth 2005; 52: 575-580.
• Imasogie N, Wong DT, Luk K, Chung F. Elimination of routine testing in patients undergoing cataract surgery allows substantial saving in laboratory costs. A brief report. Can J Anaesth 2003; 50: 246-248.
• Ajimura FY, Maia AS, Hachiya A, et al. FS. Sao Paulo Med J 2005; 123: 50-53.
• Fischer SP. Development and
• Gold BS, Young ML, Kinman JL, Kitz DS, Berlin J, Schwartz S. The utility of preoperative electrocardiograms in the ambulatory surgical patient. Arch Intern Med 1992; 152: 301-305.
• Hirsch IA, Tomlinson DL, Slogoff S, Keats AS. The overstated risk of preoperative hypokalemia. Anesth Analg 1988; 67: 131- 136.
• Nardella A, Pechet L, Synder LM. Continuous improvement, quality control, and cost containment in clinical laboratory testing. Effects of establishing and implementing guidelines for preoperative tests. Arch Pathol Lab Med 1995; 119: 518-522.
• Dzankic S, Pastor D, Gonzalez C, Leung JM. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg 2001; 93: 301-308.
• Joo HS, Wong J, Naik VN, Savoldelli GL. The value of screening preoperative chest x-rays: a systematic review. Can J Anaesth 2005; 52: 568-574.
• Fischer SP. Cost-effective preoperative evaluation and testing. Chest 1999; 115: 96S- 100S.
• Yuan H, Chung F, Wong D, Edward R. Current preoperative testing practices in ambulatory surgery are widely disparate: a survey of CAS members. Can J Anaesth 2005; 52: 675-679.
• Kozek-Langenecker S. Management of massive operative blood loss. Minerva Anestesiol 2007; 73: 401-415.
• George-Gay B, Parker K. Understanding the complete blood count with differential. J Perianesth Nurs 2003; 18: 96-114.
• Roizen MF. Preoperative laboratory testing: necessary or overkill? Can J Anaesth 2004; 51: R1-R6.
• Turnbull J, Buck C. The value of preoperative screening investigation in G. Anestezi Polikliniği. Uludağ Üniversitesi otherwise healty individuals. Arch Intern Med Tıp Fakültesi Anesteziyoloji ve Reanimasyon 1987; 147: 11-15.
• Campbell IT, Gosling P. Preoperative biochemical screening. BMJ 1988; 297; 803- 804
• Kutlay O, Özcan B, Bilgin H, Türker Anabilim Dalı Anestezi Protokolleri. 2. Baskı. Korfalı G (Ed). Logos Yayıncılık, 2006; 1-14.