Expertos Invitados





EVALUACION PREOPERATORIA DEL PACIENTE EN CIRUGIA PROGRAMADA. INDICACIONES DE LAS PRUEBAS DE LABORATORIO

(especial para SIIC © Derechos reservados)
Las pruebas rutinarias de laboratorio deben ser solicitadas por el anestesiólogo únicamente cuando en la historia clínica exista algún factor de riesgo que haga necesaria su indicación.
garciami9.jpg Autor:
F. javier García miguel
Columnista Experto de SIIC
Artículos publicados por F. javier García miguel
Coautor
Ana Domínguez Ruíz-Huerta* 
Licenciada en Medicina y Cirugía. Médico Residente en Anestesiología y Reanimación*
Recepción del artículo
4 de Febrero, 2004 		Primera edición
14 de Junio, 2004 		Segunda edición, ampliada y corregida
7 de Junio, 2021

EVALUACION PREOPERATORIA DEL PACIENTE EN CIRUGIA PROGRAMADA. INDICACIONES DE LAS PRUEBAS DE LABORATORIO

Resumen
Objetivos: Establecer un protocolo consensuado de solicitud de pruebas de laboratorio preoperatorias en cirugía programada. Revisar la evidencia científica disponible en la literatura acerca del tema en pacientes sanos asintomáticos y con enfermedad concomitante. Material y métodos: Mediante la técnica Delphy se obtuvo el consenso entre 40 miembros de las especialidades de Anestesiología y Reanimación y Cirugía General, respectivamente, para elaborar un protocolo de solicitud de pruebas preoperatorias para evaluar el estado general del paciente antes de cirugía programada. La búsqueda para identificar artículos relevantes incluyó la revisión de las siguientes bases de datos: Medline, Embase, Biological Abstracts, Science Citation Index, Cochrane Library, informes de las Agencias de Evaluación de Tecnologías Sanitarias y el National Institute for Clinical Excellence. Resultados: El 100% de los profesionales creyeron necesario evaluar preoperatoriamente todos los pacientes y establecer recomendaciones para la solicitud de las pruebas de laboratorio antes de la cirugía programada. El 85.3% consideró que dicho protocolo aportaría mayor cobertura médico-legal y el 94.2% opinó que un cuestionario sería útil para identificar pacientes sanos y asintomáticos. El período de validez del estudio oscilaría entre 3 y 12 meses en pacientes sanos y sintomáticos, respectivamente. Conclusiones: Aunque la prevalencia de anomalías encontradas en las pruebas de laboratorio es elevada no existen datos científicos que justifiquen su solicitud rutinaria. Estas deben ser solicitadas por el anestesiólogo únicamente cuando en la historia clínica exista algún factor de riesgo que haga necesaria su indicación.

Palabras clave
Valoración preoperatoria, cirugía programada, pruebas preoperatorias, electrocardiograma, garantía de calidad, efectividad, pruebas de laboratorio


Artículo completo
(castellano)
Extensión:  +/-7.5 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes
Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Anestesiología
Relacionadas: Cardiología, Cuidados Intensivos, Diagnóstico por Laboratorio, Medicina Interna



Comprar este artículo
Extensión: 7.5 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Bibliografía del artículo
  1. García-Miguel FJ, Serrano-Aguilar PG, López-Bastida J. Preoperative assessment. Lancet 2003;362:1749-57.
  2. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technology Assessment 1997;1:1-62.
  3. Pre-operative assessment. The role of the anaesthetist. The Association of Anaesthetists of Great Britain and Ireland. November 2001. Avaible from: www.aagbi.org
  4. Alcalde J, Ruiz P, Acosta F, Jaurrieta E. Proyecto para la elaboración de un protocolo de evaluación preoperatoria en cirugía programada. Cir Esp 2001;69:584-90.
  5. Smetana GW, Macpherson DS. The case against routine preoperative laboratory testing. Med Clin North Am 2003;87:7-40.
  6. Lira RP, Nascimento MA, Kara-Jose N, Arieta CE. Predictive value of preoperative tests in facetomy. Rev Saude Publica 2003;37:197-202.
  7. Roizen MF, Foss JF, Fisher SP. Preoperative evaluation. In: Miller RD, ed. Anesthesia Vol1.5th ed. New-York: Churchill Livingston. 2000;827-82.
  8. García-Miguel FJ, García Caballero J, Gómez de Caso-Canto JA. Indications for electrocardiogram in the preoperative evaluation for elective surgery. Rev Esp Anestesiol Reanim 2002;49:5-12.
  9. García-Miguel FJ, García Caballero J, Gómez de Caso-Canto JA. Indications for thoracic radiography in the preoperative evaluation for elective surgery. Rev Esp Anestesiol Reanim 2002;49:80-88.
  10. Power LM, Thackray NM. Reduction of preoperative investigations with the introduction of an anaesthetist-led preoperative assessment clinic. Anaesth Intensive Care 1999;27:481-88.
  11. Schein OD, Katz J, Bass EB, Tielsch JM, Lubomski LH, Feldman MA, et al. The value of routine preoperative medical testing before cataract surgery. N Engl J Med 2000;342:168-75.
  12. Myers LM. Preoperative evaluation. Jacksonville Medicine. 1998.
  13. Ibarra PF, Rojas MA, Sarmiento A. A prospective cost-benefit análisis of a preanesthetic assessment clinic. Anesth Analg 1998;86:S34.
  14. Escolano F, Gomar C, Alonso J, Sierra P, Cabrera JC, Castaño J. Utilidad del electrocardiograma preoperatorio en cirugía electiva. Rev Esp Anestesiol Reanim 1996;43:305-09.
  15. Escolano F, Alonso J, Gomar C, Sierra P, Castillo J, Castaño J. Use of chest x-rays taken before elective surgery. Rev Esp Anestesiol Reanim 1994;41:7-12.
  16. Barazzoni F, Grillo R, Baggi M, Biegger P, Resella R. Evaluation of the impact of guidelines for rationalizing the prescription of preoperative tests for patients ASA 1 and 2 undergoing elective surgery. Epidemiol Prev 1999;23:37-46.
  17. Vogt AW, Henson LC. Unindicated preoperative testing: ASA physical status and financial implication. J Clin Anesth 1997;9:437-41.
  18. Pérez A, Planell J, Bacardaz C, Hounie A, Franci J, Brotons C et al. Value of routine preoperative tests: a multicentre study in four general hospitals. Br J Anesth 1995;74:250-56.
  19. Davies JM, Pagenkopf D, Todd K, Werry B, Finegan BA. Comparison of selection of preoperative laboratory tests: the computer versus the anaesthetist. Can J Anaesth 1994;41:1156-60.
  20. Fischer SP. Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology 1996;85:196-206.
  21. Macpherson DS. Preoperative laboratory testing: should any test be "routine" before surgery Med Clin North Am 1993;77:289-308.
  22. Adams JG Jr, Weigelt JA, Poulos E. Usefulness of preoperative laboratory assessment of patients undergoing elective herniorraphy. Arch Surg 1992;127:801-04.
  23. Macario A, Roizen MF, Thiested RA, Kim S, Orkin FK, Phelps C. Reassessment of preoperative laboratory testing has changed the test-ordering patterns of physicians. Surgery, Gynecolgy & Obstetrics 1992;175:539-47.
  24. Charpak Y, Blery C, Chastang CL, Ben Kemmoun R, Pham J, Brage D, et al. Usefulness of selectively ordered preoperative tests. Medical Care 1988;26:95-104.
  25. Bléry C, Charpak Y, Kemmoun RB, Pham J, Brage D, Zindel G, et al. Évaluation d'un protocole de prescription sélective des examens paracliniques préopératoires chez des sujets sains. Ann Fr Anesth Réanim 1987;6:64-70.
  26. Bléry C, Charpak Y, Szatan M, Forgeaux B, Chastang C, Gandy JH. Evaluation of a protocol for selective ordering of preoperative tests. Lancet 1986;1:139-41.
  27. Muskett AD, McGreevy JM. Rational preoperative evaluation. Postgrad Med J 1986;62:925-28.
  28. Kaplan EB. Sheiner LB, Boeckmann AJ, Roizen MF, Beal SL, Cohen SN, et al. The usefulness of preoperative laboratory screening. JAMA 1985;253:3576-81.
  29. Turnbull JM, Buck C. The value of preoperative screening investigations in otherwise healthy individuals. Arch Intern Med 1987;147:1101-05.
  30. Johnson H, Jr, Knee-Loli S, Butler TA, Muñoz E, Wise L. Are routine preoperative laboratory screening tests necessary to evaluate ambulatory surgical patients Surgery 1988;104:639-45.
  31. McKee RF, Scott EM. The value of routine preoperative investigations. Ann Royal Coll Surg Engl 1987;69:160-62.
  32. Practice advisory for preanesthesia evaluation: A report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 2002;96:485-96.
  33. Pasternak LR. Preoperative screening for ambulatory patients. Anesthesiol Clin North America 2003;21:229-42.
  34. Pasternak LR. ASA practice guidelines for preanesthetic assessment. Int Anesthesiol Clin 2002;40:31-46.
  35. Roizen MF. More preoperative assessment by physicians and less by laboratory tests. N Engl J Med 2000;342:204-05.
  36. Mancuso CA. Impact of new guidelines on physicians' ordering of preoperative tests. J Gen Intern Med 1999;14:166-72.
  37. Nardella A, Pechet L, Snyder LM. Continuous improvement, quality control and cost containment in clinical laboratory testing. Effects of establishing and implementing guidelines for preoperative tests. Arch Pathol Lab Med 1995;119:518-22.
  38. Narr BJ, Warner ME, Schroeder DR. Outcomes of patients with no laboratory assessment before anesthesia and a surgical procedure. Mayo Clin Proc 1997;72:505-09.
  39. Velanovich V. The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis. Surgery 1991;109:236-43.
  40. Preoperative routines. SBU. The Swedish Council on Technology Assessment in Health Care. Stockholm: SBU may, 1989.
  41. Agence Nationale pour l'Developpement de l'Évaluation Médicale (ANDEM). Indications des examens préopératoires. Paris: ANDEM, 1992.
  42. Office for Health Technology Assessment (OSTEBA). Healthy/Asymptomatic Patient Preoperative Evaluation. Vitoria-Gasteiz: Health Department. 1995.
  43. Health Council of the Netherlands, Gezondheidsraad (GR): Preoperative evaluation. Den Haag: Health Council of the Netherlands, 1997.
  44. CAHTA (Agencia Catalana de Evaluación de Tecnologías Sanitarias). Práctica y opinión de la valoración preoperatoria en Cataluña. Barcelona: CAHTA, 1999.
  45. Documento de Síntesis INAHTA. Red Internacional de Agencias de Evaluación de Tecnologías Sanitarias (INARTA). Servicio de Evaluación de Tecnologías Sanitarias. Osteba. Departamento de Sanidad de Gobierno Vasco.
  46. Sociedad Española de Anestesiología-Reanimación y Terapia del Dolor. Evaluación preanestésica por el anestesiólogo-reanimador. Guía de práctica clínica en Anestesiología y Reanimación. Madrid: Gráficas Almogávares, 1996;9-16.
  47. Guidelines & Protocols Advisory Committee (GPAC), Medical Services Commission, and British Columbia Medical Association. Guideline for Routine Pre-operative Testing. Victoria BC. Ministry of Health, 2000.
  48. Institute for Clinical Systems Improvement. Health Care Guideline: Preoperative Evaluation. Bloomington. The ICSI, march 2002.
  49. National Institute for Clinical Excellence. Guidance on the use of preoperative tests for elective surgery. NICE Clinical Guideline nº3. 2003. London: Nacional Institute for Clinical Excellence. Avaible from: www.nice.org.uk
  50. Shaheen WH, Sharm G. Preoperative testing. http://www.emedicine.com/med/topic3172.htm. Last updated, October 2002.
  51. Pal KM, Khan IA, Safdar B. Preoperative work up: are the requirements different in a developing country J Pak Med Assoc 1998;48:339-41.
  52. Hackmann T, Steward DJ, Sheps SB. Anemia in pediatric day-surgery patients: prevalence and detection. Anesthesiology 1991;75:27-31.
  53. Harris EJ. Usefulness od preoperative testing in pediatric podiatric surgery. Does it influence clinical decisions. Clin Podiatric Med & Surg 1997;14:149-78.
  54. Narr FJ, Hansen TR, Warner MA. Preoperative laboratory screening in healthy Mayo patients: cost-effective elimination of tests and unchanged outcomes. Mayo Clin Proc 1991;66:155-59.
  55. Roy WL, Lerman J, McIntyre BG. Is preoperative haemoglobin testing justified in children undergoing minor elective surgery [see comments]. J Am Osteopath Assoc 1991;38:700-03.
  56. Keating EM, Meding JB, Faris PM, Ritter MA. Predictors of transfusion risk in elective knee surgery. Clin Orthop 1998;357:50-59.
  57. Swetech SM, Conlon JW, Messana AS. Common features associated with spinal-anaesthesia induced hypotension: a retrospective study [see comments]. J Am Osteopath Assoc 1991;91:1195-98.
  58. Rosselló PJ, Ramos Cruz A, Mayol PM. Routine laboratory tests for elective surgery in pediatric patients: are they necessary Bol Assoc Med PR 1980;72:614-23.
  59. Baron MJ, Gunter J, White P. Is the pediatric preoperative hematocrit determination necessary. South Med J 1992;1187-89.
  60. Gold BD. Wolfersberger WH. Findings from toutine urinalisys and hematocrit on ambulatory oral and maxillofacial surgery patients. J Oral Surg 1980;38:677-78.
  61. Haug RH, Reifeis RL. A prospective evaluation of the value of preoperative laboratory testing for office anesthesia and sedation. J Oral Maxillfac Sur 1999;57:16-20.
  62. Shah KB. Kleinman BS, Rao TL, Jacobs HK, Mestan K, Schaafsma M. Angina and other risk factors in patiets with cardiac diseases undergoing noncardiac operations [see comments]. Anesth Analg 1990;70:240-47.
  63. Sewell JMA, Spooner LLR, Dixon AK, Rubenstein D. Screnning investigations in the elderly. Age Ageing 1981;10:165-68.
  64. Organización Mundial de la Salud (OMS/WHO). El uso clínico de la sangre. Manual de bolsillo. Ginebra/Londres/Malta 2001.
  65. García-Erce JA, Solano VM, Cuenca J, Ortega P. La hemoglobina preoperatoria como único factor predictor de las necesidades transfusionales en la artroplastia de rodilla. Rev Esp Anestesiol Reanim 2002;49:254-60.
  66. Laglera S, Rasal S, García-Erce JA, Sánchez-Matienzo D, Pardillos C, Sánchez-Tirado JA. Actualización de la práctica transfusional entre los anestesiólogos y su impacto en el paciente quirúrgico. Rev Esp Anestesiol Reanim 2003; 50:498-503.
  67. Drouet N. Pour le groupe de travail SANGUIS. Les pratiques transfusionelles européennes: l'enquête SANGUIS. Cahiers Anesth 1994;42:425-28.
  68. Muñiz E, Ramila E, Zamora C, Castellá D, Carpio N, Corral M, et al. Resultados de un estudio multicéntrico sobre consumo de sangre en cirugía programada. Hematológica (ed esp) 2002;87(supl 2):26.
  69. Lienhart A, Auroy Y, Clergue F, Laxenaire MC, Pequignot F, Jougla E. La pratique de l'anesthésie en France en 1996. Anesthésie et techniques transfusionnelles. Ann Fr Anesth Réanim 1998:17;1374-86.
  70. Close HL, Kryzer TC, Nowling JH, Alving BM. Hemostatic assesment of patients before tonsillectomy: a prospective study. Otolaryngol Head Neck Surg 1994;111:733-38.
  71. Aghajanian A, Grimes DA. Routine prothrombin time determination before elective gynecologyc operations. Obstet Gynecol 1991;78:837-39.
  72. Bolger WE, Parsons DS, Potempa L. Preoperative hemostatic assessment of the adenotonsillectomy patient. Otolaryngol Head Neck Surg 1990;103:396-405.
  73. Burk CD, Miller L, Handler SD, Cohen AR. Preoperative history and coagulation screening in children undergoing tonsillectomy. Pediatrics 1992;89:691-95.
  74. Eisenbergerg JM, Clarke JR, Sussman SA. Prothrombin and partial thrombloplastin times as preoperative screening tests. Arch surg 1982;117:48-51.
  75. Erban SB, Kinman JL, Schwartz R. Routine use of prothrombin and partial thromboplastin times. JAMA 1989;262:2428-32.
  76. Houry S, Georgeac C, Hay JM, Fingerhut A, Boudet MJ. A prospective multicenter evaluation of preoperative hemostatic screening tests. Am J Surg 1995;170:19-23.
  77. Korte W, Truttmann B, Heim C, Stangl U, Schmid L, Kreienbuhl G. Preoperative values of molecular coagulation markers identify patients at low risk for intraoperative haemostatic disorders and excessive blood loss. Clin Chem Lab Med 1998;36:235-40.
  78. Kozak EA, Brath LK. Do "screening" coagulating tests predict bleeding in patients undergoing fiberoptic bronchoscopy with biopsy Chest 1994;106:703-05.
  79. Robbins JA, Rose SD. Partial thromblopastin time as a screening test. Ann Int Med 1979;90:796-97.
  80. Rohrer MJ, Michelotti MC, Nahwold DL. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg 1988;208:554-57.
  81. Tami TA, Parker GS, Taylor RE. Post-tonsillectomy bleeding: an evaluation of risk factors. Laryngoscope 1987;97:1307-11.
  82. Myers ER, Clarke-Pearson DL, Olt GJ, Soper JT, Berchuck A. Preoperative coagulation testing on a gynecologic oncology service. Obstet Gynecol 1994;83:438-44.
  83. Rader ES. Hematologic screening tests in patients with operative prostatic disease. Urology 1978;9:243-46.
  84. Wojtkowski TA, Rutledge JC, Matthews DC. The clinical impact of increased sensitivity PT and APTT coagulation assays. Am J Clin Pathol 1999;112:225-32.
  85. Llau JV, Bisbe E. Transfusion and hemostasis: and unavoidable commitment for the modern. Rev Esp Anestesiol Reanim 2003;50:495-97.
  86. Wong KC. Hypokaliemia and anesthetic implications. Anesth Analg 1993;77:1238-60.
  87. Vaughan RS. Potassium in the perioperative period. Br J Anesth 1991;67:194-200.
  88. Goldman L, Caldera DL, Nussbaum SR. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845-50.
  89. Kharasch ED, Bowdle TA. Hypokaliemia before induction of anesthesia and prevention by beta 2 adrenoceptor antagonism. Anesth Analg 1991;72:216-20.
  90. Hirsch IA, Tomlinson DL, Slogoff S, Keats AS. The overstated risk of preoperative hypokaliemia. Anesth Analg 1988;67:131-36.
  91. Wahr JA, Parks R, Boisgvert D, Comunale M, Fabian J, Ramsay J, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group. JAMA 1999;281:2203-10.
  92. Chung HM, Kluge R, Schrier RW. Postoperative hyponatremia. A prospective study. Arch Intern Med 1986;146:333-36.
  93. Hjortrup A, Sorensen C, Dyremose E. Influence of diabetes mellitus on operative risk. Br J Surg 1985;72:783-85.
  94. Khan NA; Ghali WA. Perioperative management of diabetes mellitus. (Up To Date Review). Up To date 2003; 11:N3. http://www.uptodated.com (accessed Jan 10, 2004).
  95. Powell-Jackson P, Greenway B, Williams R. Adverse effects of exploratory laparotomy in patients with unsuspected lever disease. Br J Surg 1982;69:449-51.
  96. O'Connor ME, Drasner K. Preoperative laboratory testing of children undergoing elective surgery. Anesth Analg 1990;70:176-80.
  97. Akin BV, Hubbell FA, Frye EB, Rucker L, Friis R. Efficacy of the routine admission urinalisys. Am J Med 1987;82:719-22.
  98. Sanders DP, McKinney FW, Harris WH. Clinical evaluation and cost-effectiveness of preoperative laboratory assessment on patients undergoing total hip arthroplasty. Orthopedics 1989;12:1449-53.
  99. Azzam FJ, Gurpreet SP, DeBoard JW, Krock JL, Kolterman SM. Preoperative pregnancy testing in adolescents. Anesth Analg 1996;82:4-7.
  100. Manley S, de Kelaita G, Joseph NJ, Salem R, Heyman HJ. Preoperative pregnancy testing in ambulatory surgery. Incidence and impact of positive results. Anesthesiology 1995;83:690-93.
  101. Pierre N. Evaluation of a pregnancy-testing protocol in adolescents undergoing surgery. J Pediatr Adolesc Gynecol 1998;11:139-41.
  102. Twersky RS, Singleton G. Preoperative pregnancy testing: "Justice and testing for all". Anesth Analg 1996;83:438-39.
  103. Wheeler M, Cote CJ. Preoperative pregnancy testing in a tertiary care children's hospital: a medico-legal conundrum. J Clin Anesth 1999;11:56-63.
  104. Gilsanz F, Santos M, Alsina E, Matute E, Pérez C. Anestesia en la embarazada para cirugía no obstétrica. Act Anestesiol Reanim 2000;10:151-53.
  105. Goodman S. Anesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol 2002;26:136-45.
  106. Kempen PM, Norton P, Vu H. A risk index for pregnancy during anesthesia. J Clin Anesth 1997;9:194-99.
Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
 Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

  English title
  Abstract
  Key words
Full text
(exclusivo a suscriptores)

Autor 
Artículos
Correspondencia

Patrocinio y reconocimiento
Imprimir esta página
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Inicio/Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008