Just wondering what kind of pre-op testing you guys order for outpatient GI cases if any ! Do you follow the standard protocol for general OR cases ? Thank you
Thank you but my question is about getting EKGs , CBCs...etc on healthy outpatients who are coming for screening colonoscopies !
You shouldn't get these for any cases, not even for OR cases, if the patients are healthy.Thank you but my question is about getting EKGs , CBCs...etc on healthy outpatients who are coming for screening colonoscopies !
You get what's pertinent. Most of the time H&P is enough. An EKG can be obtained in the admitting area, if you feel the need. Plus you don't go heavy on your sedation if you know there might be an underlying heart disease. Have a light hand on that propofol syringe; don't stress test your patients during the endoscopy (make the GI doc your partner in this), and you'll be fine most of the time, even with sick dudes. With GI, the main problem is the airway.I didn't mean 21 yo ASA 1 pts but more like 65 y/o with stable CAD, HTN, Hyperlipidemia , do you get preop labs/EKGs for those patients who are coming for screening colonoscopies ?
noneJust wondering what kind of pre-op testing you guys order for outpatient GI cases if any ! Do you follow the standard protocol for general OR cases ? Thank you
I can't help but think that when someone orders these sorts of tests on pts like these, they are really looking for a reason to cancel the case. Otherwise, they wouldn't order them because these test have very little utility in this scenario.To answer you exact question: if a 65 y/o patient has only stable CAD, HTN and hyperlipidemia, he could probably have any low-risk surgery without any further testing, in my book (especially if he has good exercise tolerance).
You get what's pertinent. Most of the time H&P is enough. An EKG can be obtained in the admitting area, if you feel the need. Plus you don't go heavy on your sedation if you know there might be an underlying heart disease. Have a light hand on that propofol syringe; don't stress test your patients during the endoscopy (make the GI doc your partner in this), and you'll be fine most of the time, even with sick dudes. With GI, the main problem is the airway.
Don't postpone the procedure for tests that have a low pre-test probability to postpone the procedure.
The enemy of good is better. Don't get stuff that has a low likelihood of changing your management, except when the consequences can be devastating. (E.g. don't give anesthesia to a patient with a AAA that was last checked 2 years ago.)
To answer you exact question: if a 65 y/o patient has only stable CAD, HTN and hyperlipidemia, he could probably have any low-risk surgery without any further testing, in my book (especially if he has good exercise tolerance).
I haven't done outpatient GI for the last few months, so this is all from long-term memory. Also, all my patients are non-intubated and in left lateral decubitus.Just curious how you quantify having a propofol bolus "light hand" in mcg/kg numbers on a 60 yo with heart disease getting a scope. 100? 300? 500? 1000? Plus Fentanyl? Plus Versed? I usually go with 500 mcg/kg (3 mL bolus on a 60 kg pt to start) but I'm just curious about your technique.