GuidelinesOther guideline
Anaesthetic Pre-operative Workup for Patients
Adapted from the NICE 2016 Guidelines
Major surgery
Minor and intermediate surgery
Other
Pre-operative clinic
Consults
Elective lists
Booking lists
Paediatric patients
Surgery grades
Major Surgery
- FBC, U&E
- CXR and ECG for ASA II - IV patients/patients over the age of 65 years.
- Lung function tests for symptomatic or uncontrolled asthmatic patients as well as patients with a smoking history of more than 20 packs years and/or wheezing
- ABG if known/suspected to have significant respiratory disease (please discuss with anaesthetist before doing the ABG if in doubt).
- Cardiologist opinion if known with cardiac disease. Discuss with the cardiologist telephonically to see if a cardiology consult/echo is necessary.
Minor and intermediate surgery
- Hb if high risk of bleeding/
- U&E and ECG for ASA II-IV patients only.
- CXR and ABG if known/suspected to have significant respiratory disease. Cardiologist opinion if known with cardiac disease. Discuss with the cardiologist telephonically to see if a cardiology consult/echo is necessary.
- ASA I patients do not need investigations.
Other
- INR for patients on warfarin
- LFTs for patients with known liver disease
- Albumin for patients with massive ascites confirmed on CT abdomen or ultrasound.
- T4 and TSH for patients with known controlled thyroid disease who have not had their levels checked in the past 3 months.
- Recent T4 and TSH levels for symptomatic patients with thyroid disease as well as patients books for thyroidectomy or molar pregnancy evacuation.
- HbA1c if not done in the last 3 months.
Pre-operative clinic
- For ASA III or IV* pit patients coming for elective surgery
- Book out-patients at ex 0697.
Consults
- Consults for ASA III should be booked with the day senior on duty at least 48 hours before planned surgery and before 12h00.
- Please ensure that all relevant and recent investigations are in the file BEFORE the consult is requested.
Elective lists
- Please ensure that patients are informed to arrive and stay in the ward between 14h00 and 18h00 the day before surgery to ensure that they are seen by the anaesthetist.
- Please ensure that all patients are dripped with an 18G or 20G working drip on the day of surgery before coming to theatre.
Booking lists
- Booking lists should be discussed with the anaesthetic consultant on the floor on the day before surgery.
- Estimated surgical time not to exceed 6 hours.
- Co-morbidities and duration of surgery are to be noted.
Paediatric patients
- Do not routinely need investigations
- Please discuss with anaesthetic consultant assigned to list if in doubt.
| ASA PS Classification | Definition | Examples, including, but not limited to: |
| ASA I | A normal healthy patient | Healthy, non-smoking, no or minimal alcohol use |
| ASA II | A patient with mild system disease | Mild disease only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (3-<BMI<40), well controlled DM/HTN, mild lung disease |
| ASA III | A patient with severe systemic disease | Substantive functional limitations; One or more moderate to severe disease. Examples include (not limited to): Poorly controlled DM or HTN, COPD, morbid obesity (BMI≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA <60 weeks, history (>3 months) of MI, CNA, TIA or CAD/stents. |
| ASA IV | A patient with severe systemic disease that is a constant threat to life | Examples include (but not limited to): recent (<3 months) MI, CVA, TIA or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis DIC, ARD or ESRD not undergoing regularly scheduled dialysis |
| ASA V | A moribund patient who is not expected to survive without the operation | Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ishemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction |
| ASA VI | A declared brain-dead patient whose organs are begin removed for donor prurposes |
adapted from www.ashq.orf (2014)
*Kindly note that HIV is a systemic disease*
Surgery grades (with examples)
Minor
- excising skin lesion
- draining breast abscess
Intermediate
- primary repair of inguinal hernia
- excising varicose veins in the leg
- tonsillectomy or adenotonsillectomy
- knee arthroscopy
Major
- total abdominal hysterectomy, total joint replacement
- endoscopic resection of prostate, thyroidectomy
- lumbar discectomy, colonic resections.