2. GUIDELINES FOR PRE-OPERATIVE INVESTIGATION

These are the guidelines for preoperative investigations to be ordered from the Pre-Admission Clinic. The aim of preoperative investigations is to screen for abnormalities which may affect peri-operative management and to provide a baseline to guide peri-operative fluid and transfusion therapy. If in doubt please discuss with surgical team or anaesthetist involved.

2.1 FBC

* Patients whose surgery may entail significant blood loss (see attached list). This provides a baseline to guide transfusion therapy.

* Patients with symptoms or signs or diagnosis of malignancy, anaemia, blood dyscrasia or significant renal disease.

2.2 Group and Hold

* Patients having surgery which may entail significant blood loss (see attached list for guidance)

2.3 Cross Matched Blood

* For surgery where blood transfusion is invariably needed or sudden catastrophic haemorrhage may occur necessitating blood in the operating theatre (see attached list).

2.4 Autologous Blood Donation

* Needs to be arranged by surgical team if considered appropriate.

2.5 Electrolytes/Urea/Creatinine

* Patients >60yrs undergoing non day only surgery

* Patients on diuretics

* Patients with diabetes

* Patients with known renal disease or with symptoms or signs suggestive of fluid and electrolyte abnormalities

* As indicated by history and examination.

* Patients for parathyroidectomy and thyroidectomy require calcium levels.

2.7 ECG

* Men > 55yrs and women >60yrs.

* Patients with the following risk factors for ischaemic heart disease : >20 pack year history of smoking, hypertension, diabetes, strong family history of ischaemic heart disease.

* Patients with known cardiac disease and no ECG in the preceding six months or with new symptoms

2.8 Chest X-ray

* Patients with malignant disease other than BCC or SCC of skin or a malignant lesion diagnosed over 5 years ago and effectively treated.

* Patients having thoracic surgery

(Both the above groups of patients normally have a chest x-ray done as part of their diagnostic workup prior to presentation at the Pre-Admission Clinic, check results of this. Repeat x-rays are obviously not necessary if results are available).

* Patients with significant lung disease having major abdominal surgery or where history and examination suggest further evaluation of cardiovascular or pulmonary disease is necessary.

* Patients at risk for TB

2.9 Spirometry

* Patients having thoracic or major abdominal surgery who smoke or have a history of lung disease.

* As indicated by history and examination to further evaluate significant lung diseases

2.10 Arterial Blood Gases

* Patients having lung resections

* Patients having thoracic or major abdominal surgery who smoke >20 pack years or have a history of significant lung disease.

* Any patients with dyspnoea at rest or on minimal exertion.

2.11 Coagulation Tests

* Patients on Warfarin

* Patients for cardiac and thyroid surgery