Preoperative investigations: Major takeaways from ISA guidelines
Karnataka: The Indian Society of Anaesthesiologists has released clinical practice guidelines that provide recommendations for routine preoperative investigations in American Society of Anesthesiologists physical status (ASA PS) 1 and 2 patients scheduled for elective surgical procedures.
The guideline, published in the Indian Journal of Anaesthesia, are prepared to promote judicious ordering of preoperative investigations, with a focus on perioperative management strategies. This will aid in better patient outcomes considering the geographic, demographic, socio-economic, and medico-legal aspects.
Preoperative investigations are critical for planning, stratification, optimization, and perioperative management of patients undergoing surgery and to improve patient outcomes. However, there is no uniformity in preoperative investigation practices despite published guidelines from professional bodies across the globe due to various factors. There are no available guidelines on the time frame of the validity of previous investigation reports when a patient is scheduled for surgery. Taking these considerations into account, the Indian Society of Anaesthesiologists (ISA) endeavored to formulate evidence-based practice guidelines for preoperative investigations.
The recommendations are given below:
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
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