5. PREOPERATIVE LABORATORY TESTING
This parameter applies only to American Society of Anesthesiologists Patient Acuity Classification I (ASA I). The ASA has established patient acuity classifications I - VI. These reflect the medical status of the patient prior to the surgery. As such, they represent a combination of both acute and chronic diseases. They do not reflect the magnitude of the proposed surgery. They are not age dependent.
ASA Classification I is a healthy patient with no underlying systemic diseases.
ASA Classifications II-VI represent patients with increasing severity of medical disease. As these standards for preoperative testing criteria only apply to patients in ASA I Classification, these ASA Classifications II-VI are not described.
A. STANDARD: ANESTHESIA PREOPERATIVE TESTING
SURGICAL PROCEDURE: excludes extensive major body cavity, expected significant (e.g., 10%) blood loss or extensive manipulation of physiological variables (i.e., induced hypotension).
TABLE 1: PREOPERATIVE TESTS TO BE PERFORMED ACCORDING TO AGE AND OTHER PATIENT ATTRIBUTES.
Column Headings have the following meanings: Spnl/Epi = Spinal/Epidural; MAC = Monitored Anesthesia Care; P. BLK = Peripheral Block (i.e., Axillary, etc.); I.V. Blk = Bier
ANESTHESIA PREOPERATIVE TESTS FOR ASA I PATIENTS
January 1993
1. 2. 3. 4. 5. 6.
General. Spnl/Epi. MAC Prph. Blk. IV Blk. Local
A. Hct. Hct. -0- -0- -0- -0-
0-6 mos. 1 mos. 1 mos.
B. -0- -0- -0- -0- -0- -0-
6 mos-40 yrs.
C. E. K. G. E. K. G. -0- -0- -0- -0-
40-50 yrs. 2 yrs. 2 yrs.
male only
D. Hct. Hct. Hct. -0- -0- -0-
50-65 yrs. 6 mos. 6 mos. 6 mos.
E.K.G. E.K.G.
1 yr. 1 yr.
E. Hct. Hct. Hct. Hct. -0- -0-
65-75 yrs. 6 mos. 6 mos. 6 mos. 6 mos.
BUN/Gluc. BUN/Gluc.
6 mos. 6 mos.
E.K.G. E.K.G. E.K.G.
1 yr. 1 yr. 1 yr.
F. Hct. Hct. Hct. Hct. Hct. -0-
75 + yrs. 6 mos. 6 mos. 6 mos. 6 mos. 6 mos.
BUN/Gluc. BUN/Gluc. BUN/Gluc.
6 mos. 6 mos. 6 mos.
E.K.G. E.K.G. E.K.G. E.K.G. E.K.G.
1 yr. 1 yr. 1 yr. 1 yr. 1 yr.
CXR. CXR. CXR.
1 yr. 1 yr. 1 yr.
As well as the above testing, for ASA Classification I patients, regardless of sex or age, who are undergoing procedures with potential for significant blood loss (i.e., 10%, the minimum testing is a Hematocrit within two weeks with type and screening of blood products.
B. CRITERIA FOR ANESTHETIC PREOPERATIVE TESTING CRITERIA
(1) Each patient will have an appropriate preoperative history and physical examination prior to the proposed surgery.
(2) These preoperative parameters only apply to the anesthetic management of the patient. The surgical management of the patient may require additional testing, although frequently there will be overlap.
(3) These parameters only apply to elective surgery.
(4) These parameters do NOT apply to those patients who are going to have:
(a) Surgery involving extensive major body cavity procedures;
(b) Surgery with anticipated major blood loss; and/or
(c) Surgery requiring extensive manipulation of physiological variables.
(5) These parameters do-NOT apply to those patients who have developed an acute process in addition to or separate from the surgical process necessitating the operation.
(6) Duplicate data is acceptable, provided it meets the following criteria:
(a) The name of the physician (clinic/office) managing the patient's disease;
(b) The location of the practice if not in the immediate vicinity;
(c) At least a verbal report, which may come from the patient if the patient is felt to be a reliable historian, of any indicated tests. (Hard copy is preferred); and
(d) The approximate date of the test.
(7) The anesthetic preoperative evaluation and testing is directed towards developing the appropriate anesthetic care plan. It is not the equivalent of or a substitute for an annual physical examination or other similar screening process.
EFFECTIVE DATE: July 28, 1991
AMENDED: February 22, 1995
|
|
|
