Pre-operative Star Panel

Most patients who are having surgery have their preoperative risk evaluated by medical advisors. The subject of this article's discussion pertains to healthy individuals who will be undergoing an elective surgical operation. The use of laboratory testing before surgery became widespread in clinical practice worldwide despite the minimal risk of perioperative complications. Clinicians at the time reasoned that ordering tests to look for anomalies that may raise morbidity or death in the perioperative period was sensible.

Pre-Operative Screening Panel Overview

Most patients who are having surgery have their preoperative risk evaluated by medical advisors. The subject of this article's discussion pertains to healthy individuals who will be undergoing an elective surgical operation. The use of laboratory testing before surgery became widespread in clinical practice worldwide despite the minimal risk of perioperative complications. Clinicians at the time reasoned that ordering tests to look for anomalies that may raise morbidity or death in the perioperative period was sensible.

What is Pre-Operative Screening Panel and What Does It Include?

Preoperative exams are a series of tests performed before a scheduled procedure. Even if you seem to be in good health, these tests may be performed to learn more about any issues that could have an impact on the type of care you require. Your age, general health, any diseases you may have or medications you may be taking, and the type of procedure you will have will influence the tests you will have before the operation.

Before surgery, the following tests are frequently performed:

A chest X-ray. X-rays can be used to identify the reasons for cough, fever, chest discomfort, and shortness of breath. Additionally, they can aid in the diagnosis of aberrant lung, breathing, and heart sounds.

Electrocardiogram (ECG). The heart's electrical activity is captured by this test. It reveals irregular heartbeats (arrhythmias or dysrhythmias), identifies cardiac muscle injury, and aids in determining the origin of chest discomfort, palpitations, and heart murmurs.

Urinalysis. This examination can be used to identify diabetes, kidney, bladder, and other infections. In some cases, urinalyses might also reveal the presence of illicit narcotics in the body.

White blood cell count. This examination can aid in the diagnosis of several fevers and illnesses. Additionally, it can reveal whether a person is taking any drugs that lower white blood cell levels.

Glucose. This examination checks the levels of blood sugar.

Potassium. The electrolytes in your blood, including potassium, sodium, and other substances, are measured by this test. Other bodily processes and cardiac rhythms are regulated by these substances.

CBC. Anaemia (a low level of red blood cells) and infection are both screened for by this test.

Studies on coagulation (PT/PTT). These screening tests determine how successfully your blood clots.

When they discover comorbid or other major medical diseases in the patient's body, surgeons will either postpone the operation or cancel it. The National Institute for Health and Care Excellence (NICE) advises preoperative serum tests, and only significant blood tests will be recommended by surgeons.

• Hypertension and cardiovascular disease; physical activity tolerance is a good marker of cardiovascular fitness and, especially for patients having major surgery, can help estimate their risk of postoperative problems and the amount of postoperative care required. By screening sessions like the existence of exertional chest discomfort, syncopal episodes, or orthopnoea, screening questions may reveal undiscovered illnesses and encourage further research.
• Respiratory disorders, since preventing acute ischemia events during the perioperative phase requires appropriate oxygenation and ventilation. The ability to lie flat for an extended amount of time and the presence of a persistent cough are crucial considerations since they may rule out the use of spinal anaesthesia. If the patient has any risk factors, it's also important to check for symptoms and indications of obstructive sleep apnoea.
• Renal disease, their baseline renal function, and any drugs specifically for the kidneys.
• Endocrine disorders, including thyroid and diabetes mellitus.
• Gastro-oesophageal reflux (GORD), which might be lethal if stomach contents are aspirated. The presence of GORD will likely change how anaesthesia is administered. While this may go unnoticed as a diagnosis or in their prior medical history, especially if the patient was treated with over-the-counter medications, it is crucial to inquire about it during the pre-operative examination.

It could also be helpful to ask oneself the following particular questions:

• Pregnancy – as part of the pre-operative checklist on the day of surgery, undergo urinary pregnancy test.
• Sickle Cell Disease – could they have undiagnosed sickle cell disease, especially if their country of birth does not have routine screening for sickle cell.
• MRSA testing MRSA stands for Methicillin-resistant Staphylococcus aureus. The bacteria live in many people’s skin without causing any harm, but it causes infection once it enters the body, particularly in people with poor health. This test is done to detect the presence of this bacteria in your body.

Preparation and Procedure of Pre-Operative Screening Panel Tests

The preparation procedure is easy to understand. 12 hours of fasting is required for the screening tests. Drink a couple of litres of water to keep yourself hydrated. Depending on a patient's health, a doctor may advise a few blood tests or several serum tests.

• The method used to obtain serum samples varies from patient to patient.
• Doctors will advise taking several blood samples, including full blood counts, blood coagulation tests, diabetes testing, urine dip tests, and blood gases, from patients who are getting ready for significant procedures.
• It might be a highly drawn-out or quick process.
• Patients should adhere to the instructions provided by the specialists.
• Sterilized or fresh syringes will be used by doctors or lab personnel to draw blood from patients.
• You may experience discomfort, bruise, and other minor issues, but these issues will pass in a matter of minutes.

Pre-Operative Investigations and Result Interpretation

The type of precise examinations needed will vary depending on a variety of variables, including co-morbidities, age, and the procedure's nature.

• Full Blood Count - The majority of patients will have a complete blood count, which is primarily used to check for any anaemia or thrombocytopenia that may need to be corrected before surgery to lower the risk of cardiovascular events or to enable the manufacture of blood products.
• Urea and Electrolytes - to evaluate the renal function at baseline to aid with fluid management and medication choices for anaesthesia and postoperative analgesia.
• LFT (Liver function Test) – It is important for perioperative treatment, monitoring liver metabolism and synthesising function. If there is a suspicion of liver impairment, LFTs may assist guide drug selection and dosage.
• It is also used to check HbA1C levels or thyroid function checks.
• Clotting test - Any signs of abnormal coagulation, such as those brought on by warfarin, genetic coagulopathies such as haemophilia A/B, or liver dysfunction, must be identified and treated correctly during the perioperative period.
• Cardiac study - ECG helps to find if a person has a history of cardiovascular illness. For the anaesthetist, information from an echocardiogram (ECHO) is extremely helpful since it allows for risk stratification and customization of the patient's intraoperative treatment. A cardiac murmur, ECG abnormalities, or signs or symptoms of heart failure are all possible considerations.
• Respiratory Analysis - Plain film chest radiographs (CXR) should only be used when essential to identify the symptoms and signs of an undiscovered pulmonary illness. They are less frequently performed routinely before surgery.
• Urinalysis - A urinalysis is done to see if there is any evidence or reason to believe that a urinary tract infection is still present.
• MRSA Swabs – If the test is positive, it means there are bacteria living on the skin or in the nose.