Preop CXRs

[Mman]

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who needs 'em? In other words, what patient or what case will you hold up to get one? In what patient or what case will it change how you manage things?

 

[seinfeld]

i dont even look to see if one was done unless the patients history is bad enough to suggest acute intraop problems. I dont think a CXR alone (without associated Hx) would alter how I conduct an anesthetic.

I most frequent time i request them is in the outpt setting where the patient comes in with a hx of new or worsening SOB, or recent cold symptoms with wheezing, rhonchi or crackles in PE

 

[IlDestriero]

who needs 'em? In other words, what patient or what case will you hold up to get one? In what patient or what case will it change how you manage things?

Some peds cancer patients require a pre anesthesia cxr, especially a new presentation. Vague symptoms, tired, new mass for biopsy. Hello giant mediastinal mass. Happens frequently in my neck of the woods. It might change your plan... Sometimes we get a TTE as well.

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Il D

 

[Mman]

i dont even look to see if one was done unless the patients history is bad enough to suggest acute intraop problems. I dont think a CXR alone (without associated Hx) would alter how I conduct an anesthetic.

I most frequent time i request them is in the outpt setting where the patient comes in with a hx of new or worsening SOB, or recent cold symptoms with wheezing, rhonchi or crackles in PE

Is not looking to see if one was done reasonable? IMHO if something happened and then they later say well didn't you see the CXR before surgery that showed such and such? What do you think? Admitting you never even looked kinda looks bad. That's why I hate that so many get done. Just makes more work for me to look at them all.

 

[PinchandBurn]

I feel like it was a quick and easy way to follow up and look at CHF exacerbation,etc if cardiomegaly was present. Nowadays, I think most people look at echos,etc.

Perhaps a really bad COPDer would need one. But even then, I think most of us woudl look at the patients symptoms versus what is on a CXR..

I think CXrs atleast for PreOp is more historical than anything....

 

[Idiopathic]

our preop clinic has an algorithm for CXR, I rarely look at them if no symptoms and have ordered maybe 1 on a patient in holding.

i guess to answer your question, i will hold up any case for someone who arrives in distress or who has an increasing oxygen requirement without known cause.

 

[seinfeld]

unless it was done an hour before the case i don't see the point. A new mass on CXR usually gets a surgery cancelled or an output consult. I agree that getting one for the sake of getting one is stupid,

 

[europeman]

As a surgeon I find them useful for thoracic or abdominal wacks in high risk or elderly patients so I have something to compare to post op if they have reason to get post op x ray.

 

[okayplayer]

In thoracotomy patients I will have a look at their CXR (if no CT in our system) to measure tracheal diameter to help decide what size DLT to place. Little tip I picked up from one of our CT attendings.

Otherwise I agree they are of limited value in patients coming in from home, other than for making observations like "wow this guy's COPD is pretty advanced," or "impressive cardiomegaly" (which TTE and PFTs/functional status are infinitely more useful for).

 

[BLADEMDA]

http://www.anesthesia-analgesia.org/content/107/1/342.1.full



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