Preoperative investigations: Major takeaways from ISA guidelines

Recommendation 1: Preoperative complete blood count testing is suggested for patients undergoing minor, intermediate, and major surgery.

Recommendation 2a: Preoperative serum creatinine estimation is NOT suggested for patients undergoing minor surgery.

Recommendation 2b: Preoperative serum creatinine estimation is suggested for patients undergoing intermediate and major surgery.

Recommendation 3: Preoperative serum sodium and potassium estimation is NOT suggested for patients undergoing minor, intermediate, and major surgery.

Recommendation 4a: Preoperative liver function testing is NOT suggested for patients undergoing minor and intermediate surgery

Recommendation 4b: Preoperative liver function testing is suggested for patients undergoing major surgery

Recommendation 5: Preoperative coagulation profile (PT/INR and aPTT) testing is NOT suggested for patients undergoing minor, intermediate, and major surgery.

Recommendation 6: In non-diabetic patients, pre-operative blood glucose estimation is NOT suggested when scheduled to undergo minor, intermediate, and major surgery.

Recommendation 7a: In non-cardiac patients, pre-operative 12-lead electrocardiogram testing is suggested at age 45 years and above, when scheduled to undergo minor and intermediate surgery.

Recommendation 7b: Preoperative 12-lead electrocardiogram testing is suggested for all patients undergoing major surgery.

Recommendation 8a: Preoperative chest X-ray testing is NOT suggested for patients undergoing minor surgery.

Recommendation 8b: Preoperative chest X-ray testing is suggested for patients aged 50 years and above, undergoing intermediate and major surgery

Recommendation 9: Routine preoperative ultrasonographic airway assessment is NOT suggested for predicting difficult laryngoscopy.

Recommendation 10a: The acceptable validity time (VTPIN) for a previously performed normal complete blood count, renal function tests, liver function tests, and coagulation profile, is suggested to be 2 months provided the clinical condition of the patient has not changed in the intervening period.

Recommendation 10b: The acceptable validity time (VTPIN) for a previously performed normal 12-lead electrocardiogram and chest X-ray, is suggested to be 12 months provided the clinical condition of the patient has not changed in the intervening period.

"One study (n = 150, 18-60 years) concluded that preoperative ultrasonographic airway assessment was not superior to clinical evaluation in predicting difficult laryngoscopy.," the researchers wrote. "The outcomes from these additional evidences were in agreement with the formulated recommendations. Hence, these guidelines stand valid with the latest evidence."

Reference:

Umesh, Goneppanavar,; Bhaskar, S. Bala1; Harsoor, S. S.2; Dongare, Pradeep A.3; Garg, Rakesh4; Kannan, Sudheesh5; Ali, Zulfiqar6; Nair, Abhijit7; Bhure, Anjali Rakesh8; Grewal, Anju9; Singh, Baljit10; Rao, Durga Prasad11; Divatia, Jigeeshu Vasishtha12; Sinha, Mahesh13; Kumar, Manoj14; Joshi, Muralidhar15; Shastri, Naman16; Malhotra, Naveen17; Saikia, Priyam18; MC, Rajesh19; Das, Sabyasachi20; Ghosh, Santu21; M, Subramanyam22; Tantry, Thrivikrama23; Mangal, Vandana24; Keshavan, Venkatesh H.25. Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian Journal of Anaesthesia: May 2022 - Volume 66 - Issue 5 - p 319-343 doi: 10.4103/ija.ija_335_22