Preoperative Testing

Local Doctor:
An H&P is NOT a 'clearance for surgery'. We do that.
 An H&P = an H&P. Nothing weird.
What is normal counts.

    Preoperative Testing

 & Booking Surgery

Surgery may well be one of the most rigorously planned events any human will experience in their lifetime. The single most compelling desire is that things go according to plan. The key to plans working is a handle on variables guarding against the unforeseen. Of course the wild cards we fear most are unknown allergies, drug intolerance and infection.

Humans are as varied in their internal anatomy and chemistry as they are in their faces, voices, handwriting, and favored pastimes. That biologic variety is an every day factor in the practice of medicine and is why cookbook medicine not only doesn't work but is dangerous.

Children don't need preop tests according to the cookbook. When dealing with the subset of children with chronic conditions, that assumption based on data from an overwhelmingly healthy population is flat out wrong. Almost 40% of children with cerebral palsy have some other deeper systemic issue which underlies the diagnosis. Additionally, the events that lead to neurologic damage are not specific, and can and do damage other organs.
As a safe rule, children with global condition diagnoses such as CP or spina bifida etc. ought to at least have comprehensive tests done once. If those are normal, and the condition is not known to have progressive elements, then those tests can be reviewed for even later purposes without repetition. There is no reason to think that a child with CP and an initial cardiogram that is normal is going to acquire heart disease unless a suspicious illness intervenes.

What are reasonable one time pre anesthesia exams and what might they show (only including our own actual findings here): 

    Chest x-ray : reversed heart, bowels in the chest displacing 70% of lung space (diaphragm hernia), massive pericardial effusion (with tamponade explaining the laziness), tumor, TB, missing thymus (immune deficient), array of metallic swallowed stuff including open safety pin, unseen scoliosis and unrecognized pneumonia.  

    Ekg : Wolf-Parkinson-White syndrome, and a variety of cardiac conduction defects which are predisposed to problems with certain anesthetics, cardiomyopathy, etc.

    Electrolytes Plus : Diabetes, complete renal failure ("healthy" 9 y/o glue sniffer), rickets, potassium loser (at cardiac risk), chronic bowel syndromes, parathyroid disorders, hepatitis, and others

    Clotting profile : chronic rat poisoning (they eat off the floor), clotting disorders related to seizure med drug interactions, and inherent familial defects.

    CBC : malaria, leukemia, parasitosis, etc.

    Urine analysis : - diabetes, kidney disorders, chronic infection etc., dehydration

We do not require that these fairly fundamental tests be conducted by us, but just that they be done. They are reviewed by us as well as by your own physician at home. Your own physician performs a history and physical (history is a series of questions that are to both uncover potential problems and also to assure the operative team that specifics have been asked and found to be negative). A good history is the cornerstone of all medical practice. It ought to be clear and complete. The physical, well, say ahhhhhhhh. You know that one.

Single most frequent (and important) pretest abnormality? Urine specific gravity. Go to the top of the page and check out 'Chronic Shock' when you are done here. It's about water. Did you know that water is important? Fish know it in a fishy way. Many parents of children with mobility issues don't seem to. Trust me. You do not want to travel over an ocean to learn that your child does not have enough water.

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