Yalçın EREM, Seda Banu AKINCI, A.Heves KARAGÖZ, Özgür CANBAY, Saadet ÖZGEN

Günübirlik anestezi öncesi yapılan tetkikler ne kadar gerekli

Amaç: Bu çalışma, ürolojik cerrahi girişimlerin uygulanacağı hastalarda, anestezi öncesi yapılan rutin tetkiklerden hangilerinin, preoperatif vizitte alınan hikaye ve yapılan fizik muayeneye göre belirlenecek anestezi planında değişikliğe sebep olacak kadar gerekli olduğunu incelemeyi amaçlamaktadır. Yöntem: Cerrahi girişim sabahı, anestezi doktoru tarafından tüm hastalardan ayrıntılı hikaye alınmış, fizik muayene ve ASA sınıflandırması yapılıp anestezi planı hazırlanmıştır. Sonrasında hastaların preoperatif rutin tetkikleri incelenerek anestezi planında bir değişiklik varsa kaydedilmiştir. Bulgular: Dört yüz günübirlik cerrahi hastası üzerinde yaptığımız bu çalışmada rutin tetkikler görüldükten sonra 7 hastada (%1.8) anestezi planında değişiklik yapıldı. Düzenli doktor kontrolü varlığının anestezi planını değiştirmediği görüldü. 260 hastada , (%65) normal olmayan laboratuvar testleri tespit edildi, sadece 4 hastada anestezi yönteminin değişmesine, 3 hastada ise ek tetkik ihtiyacına sebep oldu. Normal olmayan preoperatif laboratuvar testleri ile anestezi planı arasında anlamlı bir ilişki saptanmadı. Anestezi plan değişikliğinin hastaların ASA sınıfından etkilendiği görüldü (p

How much routune preoperative testing is enough for ambulatory anesthesia

Objective: This study is designed to investigate which of the routine preoperative tests are necessary to change the anesthetic plan for the patients undergoing urological operations. Method: On the morning of the surgery, the anesthesiologist obtained detailed previous medical history, performed physical examination and rated ASA classification and prepared the anesthesia plan. Afterwards, any change in the anesthetic plan was recorded if deemed necessary after reviewing the preoperative routine laboratory investigations of the patients. Results: In 7 (1.8%) patients out of 400 ambulatory anesthesia patients included into our study, anesthetic plans were changed after reviewing the routine tests. Routine medical control did not change the anesthetic method. 260 patients (65%) had abnormal laboratory investigations that led to a change in anesthetic management in 4 patients and the need for additional investigation in 3 patients. We found no relation between the abnormal preoperative tests and anesthetic method change. ASA physical status classification predicted a change in the anesthetic method (p<0.01). The anesthetic method was effected by the history of coronary artery disease, cardiac failure and chronic obstructive pulmonary disease, evaluated at the preoperative visit. Of the preoperative tests, only ECG and chest x-ray changed the anesthetic method, only if have been done for recognizable indications such as in cardiopulmonary disorders. Conclusion: In conclusion preoperative tests for ambulatory anesthesia must be planned according to recognizable indications obtained from the patient's history and physical examination at preoperative visit.

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