Preanestecia evaluacion

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PRACTICE ADVISORY FOR PREANESTHESIA EVALUATION
Introduction. 2
A. Definition of Preanesthesia Evaluation. 2
B. Purposes of the Advisory for Preanesthesia Evaluation. 3
C. Focus. 3
D. Application. 3
E. Criteria for Anesthesia Intervention, Testing, and Consultation. 3
F. Task Force Members and Consultants. 4
G. Availability and Strength of Evidence. 4
I. Preanesthetic History and PhysicalExamination. 4
A. Impact. 4
B. Timing. 5
II. Selection and Timing of Preoperative Tests. 7
Electrocardiogram (ECG): 7
Other cardiac evaluation: 7
Chest X-Ray: 8
Pulmonary Evaluation (i.e., Pulmonary Function Tests, Spirometry): 8
Hemoglobin/Hematocrit Measurement: 8
Coagulation Studies: 8
Serum Chemistries: 9
Urine Testing: 9
Pregnancy Testing: 9
Routine Preoperative Testing. 10Preoperative Testing in the Presence of Specific Clinical Characteristics. 10
Electrocardiogram (ECG): 10
Preanesthesia Cardiac Evaluation (other than ECG): 11
Preanesthesia Chest Radiographs (X-Ray): 11
Preanesthesia Pulmonary Evaluation (Other than Chest X-ray): 11
Preanesthesia Hemoglobin or Hematocrit: 11
Preanesthesia Coagulation Studies (e.g., INR, PT, PTT, platelets): 12
PreanesthesiaSerum Chemistries (i.e., potassium, glucose, sodium, renal and liver 12
Preanesthesia Urinalysis: 12
Preanesthesia Pregnancy Testing: 12
Timing of Preoperative Testing. 12
III. Summary and Conclusions. 13
�Routine preoperative tests (i.e., tests intended to discover a disease or disorder in an. 14
•Selective preoperative tests (i.e., tests ordered after consideration of specific. 14•Decision-making parameters or “rules” for specific preoperative tests or for the timing. 14
Patient Characteristics for Selected Preoperative Testing. 14
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Introduction(Back to the top)
Practice advisories are systematically developed reports that are intended to assist decision-making in areas of patient care where scientific evidence is insufficient to develop an evidence-basedmodel. Practice advisories provide a synthesis of opinion from experts, open forums, and other public sources. Practice advisories report the current state of scientific literature, but are not supported by literature to the same degree as standards or guidelines due to the lack of sufficient numbers of adequately controlled studies.
  Advisories are not intended as guidelines, standards, or absoluterequirements. The use of practice advisories cannot guarantee any specific outcome. They may be adopted, modified, or rejected according to clinical needs and constraints. Practice advisories are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.
 
A. Definition of Preanesthesia Evaluation(Back to the top)
The literature does not providea standard definition for preanesthesia evaluation. For this
Practice Advisory, the preanesthetic evaluation is defined as the process of clinical assessment that precedes the delivery of anesthesia care for surgery and for non-surgical procedures. For this Advisory, "perioperative" refers to the care surrounding operations and procedures. The preanesthetic evaluation is the responsibility of theanesthesiologist.
Preanesthesia evaluation consists of the consideration of information from multiple sources that may include the patient's medical records, interview, physical examination, and findings from medical tests and evaluations. As part of the preanesthetic evaluation process, the anesthesiologist may choose to consult with other health care professionals to obtain information orservices that are relevant to perioperative anesthetic care. Preoperative tests, as a component of the preanesthesia evaluation, may be indicated for various purposes, including but not limited to: 1) discovery or identification of a disease or disorder which may affect perioperative anesthetic care, 2) verification or assessment of an already known disease, disorder, medical or alternative...
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