How important is an Echo to an anaesth?

[ici_cute]

I've got calls from my colleagues in gen surg/subspecialty that they need an echo because the anaesth ordered and the patient is going for op...oh...tomorrow.

Is it that important? It's understandable if the patient is a high risk patient with multiple underlying medical illness and risk factor for cardiac event is there. Sometimes they order for patient with 'biggish' heart on Chest Xray but no clinical symptoms or signs.

Please comment...coz sometimes they are pushing the limit.

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[Myostatin]

I'm not sure why anesthesiologists are ordering echos... if a patient is of any signficant risk the surgeon will refer to an internist for pre-op clearance, who should be ordering the echos if indicated. There's no point in doing the test unless you're going to act on the information, so how is an echo going to change your management?

Knowing that a patient has a poor EF might keep you from flooding a patient with fluid in the OR, but why wouldn't you be judicious about the use of fluids to begin with? Also, chances of a patient w/ good exercise tolerance that would otherwise not require pre-op risk stratification in the way of a stress test having a poor EF... minimal.

The only other thing would be significant valvular disease for a moderate or high risk non-emergent procedure. But this should be detectable on an h&p - the chances of finding signficant valvular disease in a patient with a normal exam (i.e. no murmur) and no symptoms is so negligible as to not be worth doing the test.

Does an 80 y/o w/ no cardiac or pulmonary history and good exercise tolerance, who you would not stress prior to say a fracture repair need a routine echo preoperatively.... no.

 

[radslooking]

i think echos are grossly overused.

people have completely forgotten clinical judgment. exercise tolerance is better than an echo any day if you're worried about them tolerating surgery.

i've been seeing random echos for routine admits for "chest pain". I'm not quite sure what they're looking for....and i think the same can be said for a pre-op echo like you described. People are treating echo's like its a 75 dollar ECG. we should be a little more judicious with our resources.