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. 2019 Nov 27;67(1):64–99. doi: 10.1007/s12630-019-01507-4
T est I ndications
Complete blood count • May be considered based on the potential for significant blood loss, extremes of age (i.e., < one year), liver or hematological disease, history of anemia or malignancy.
Sickle cell screen • Should be offered with counselling to patients of high risk ethnicity.
Partial thromboplastin time/international normalized ratio

May be considered:

• with conditions or medications associated with impaired coagulation (e.g., liver disease, malnutrition), history of excessive bleeding, or a family history of heritable coagulopathies

• for patients on oral or parenteral anticoagulant therapy.

Electrolytes

May be considered:

• with known or compelling findings in favour of hypertension, congestive heart failure, chronic renal failure, complicated diabetes, liver disease, pituitary-adrenal disease, malnutrition

• for patients taking diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and other therapy affecting electrolytes.

Creatinine and estimated glomerular filtration rate (eGFR)

May be considered:

• as above for electrolytes, also with advanced age and for patients taking medications potentially affecting renal function

• for patients receiving direct oral anticoagulants

• as required for calculating perioperative risk indices

• eGFR is recommended to assist with renal outcome prediction.

Fasting glucose level

May be considered:

• for diabetics, preoperatively on day of surgery to guide glycemic control

• for patients on glucocorticoid therapy

• as screening for body mass index > 40 or a very high risk of diabetes based on signs and symptoms.

Hemoglobin A1c • May be considered for known diabetics as early as possible before surgery (ideally at time of surgical referral) if results would change management.
Pregnancy testing

Based on specific institutional guidelines

• Should be offered to women of childbearing age based on any reasonable likelihood of pregnancy, on the reliability of menstrual history, and if the results will cancel or change the procedure or the anesthetic management.

• Point of care urine or blood testing capability is ideal and is therefore recommended.

Electrocardiography

• May be considered for patients with known or suspected coronary heart disease, significant arrhythmia, peripheral vascular disease, or other significant structural heart disease.

• May be considered in the absence of symptoms or known cardiovascular disease in patients having high-risk surgery in the presence of clinical risk factors (e.g., Revised Cardiac Risk Index (RCRI) or American College of Surgeons (ACS) Surgical Risk Calculator).

Resting echocardiography • May be considered if clinical assessment suggests undiagnosed severe obstructive intra-cardiac abnormality, cardiomyopathy, or severe pulmonary hypertension.
Chest radiograph

• Not recommended for asymptomatic patients in routine preoperative assessment unless part of a surgical or oncological workup unrelated to perioperative risk assessment.

• May be considered for patients with acute or chronic cardiopulmonary disease based on history and physical exam if it will change management.