Pre-anaesthetic testing - numbers done and results

RE: Pre-anaesthetic testing - numbers done and results

Anthony Todd — Tue, 06 Jun 2017 14:39:12 GMT

The transformation of blood tests from enlightening diagnostic tools to “because we can” tasks is built on availability, which has helped cement a culture of clinical over investigation. Ordering unnecessary tests is driven by the fear of missing important clinical details and the potential for subsequent litigation. We therefore need to change the underpinning psyche of traditional clinical decision making from “can this test give me more information?” to “will the result of this test change the management of my patient?”

BMJ 2017;357:j2091 doi: 10.1136/bmj.j2091 (Published 2017 May 03)

Cherry picked from the last section and pretty much what I think in a lot of cases these days, and certainly in PABs.

RE: Pre-anaesthetic testing - numbers done and results

Neil Wheadon — Mon, 05 Jun 2017 16:13:18 GMT

www.vetsurgeon.org/.../routine-blood-tests-BMJ.pdfHi Mariette

Can you give the gist of it?

Neil

I also enclose a very recent article in the BMJ. Basically we waste billions on these in the NHS every year

RE: Pre-anaesthetic testing - numbers done and results

mariette asselbergs — Mon, 05 Jun 2017 13:52:53 GMT

See BSAVA Companion June 2017 Carl Bradbrook (RCVS and uropean specialist in Anaesthesia and Analgesia with his rationale about PABs and other interesting topics (NSAIDs, CRIs and starving pre-op).

Mariette

RE: Pre-anaesthetic testing - numbers done and results

Anthony Dennison — Fri, 02 Jun 2017 12:56:05 GMT

As I fear this may be lost in the argument on the other thread, I'll post this here. I've just quickly looked back at the last 2 weeks of ops at our main hospital. Our policy is anything other than neutering will get PABs.

Number of PABs taken: 26

Number of abnormalities detected on PABs: 8

1 of the 8 had a high ALKP, which had been high on a previous test but was higher than that baseline

4 of the 8 had raised globulins (interestingly enough, all dentals)

1 of the 8 had slightly raised Urea, likely dehydration from pre-op fasting

1 of the 8 had slightly raised ALT, but as discussed previously this doesn't really mean anything

1 of the 8 had raised globulins and an ALKP in the 1000s. An 8 year old boxer in for a mass removal on the foot. Mass removal was postponed, a BAST was performed and the mass FNAd only.

RE: Pre-anaesthetic testing - numbers done and results

Rob Loxley — Thu, 01 Jun 2017 17:23:26 GMT

[quote user="Neil Wheadon"]Either participate, ignore it but please don't keep picking at it.[/quote]

Maybe I'm being dim, but I don't understand what your poll is asking for:

"Simply use the poll for the number you did
If any abnormalities use the comment to say what. Minimum, species, age, what was found

Rules
10 years and under
Fit animal"

Number I did of what, over what period (your answer choices only go up to 9), that were normal (is 1-9 this?), that showed abnormalities (or this?), that changed the anaesthetic in any way, what do you mean 'minimum needed'??

RE: Pre-anaesthetic testing - numbers done and results

Neil Wheadon — Wed, 31 May 2017 08:51:04 GMT

[quote user="Gillian Mostyn"]Maybe not. But your survey is fishing for the odd results that people happen to remember [/quote]

Only if they chose to do that. I really can't sit on their shoulders and say put that in. It's not a BSAVA funded article or something like that it's an indication, a bit of light relief, call it what you like, because like far to many clinical discussions on this site it will sink into oblivion before being given a chance.

Or maybe I shouldn't bother at all and we can descend into the other pre-anaesthetic discussion. Either participate, ignore it but please don't keep picking at it.

Slightly fed up now and signing out, let it sink into the depths

Neil

RE: Pre-anaesthetic testing - numbers done and results

Gillian Mostyn — Tue, 30 May 2017 23:25:21 GMT

Maybe not. But your survey is fishing for the odd results that people happen to remember (whether clinically significant or not) rather than a true representative sample.

RE: Pre-anaesthetic testing - numbers done and results

Neil Wheadon — Tue, 30 May 2017 22:30:43 GMT

Hi Gillian

If you start to pick, pick at it, then it won't get anywhere.

It's a generalisation, a finger in the air. If you have a 10 year old Great Dane and are blood testing for something then it probably isn't clinically normal. Besides I did put, if you did get an abnormal then tell us what you found. If a zillion cats are posted at 10 having a high creatinine then maybe people will think about offering bloods routinely for 10 year olds.

If you make things complicated no-one will do it will they?

Neil

RE: Pre-anaesthetic testing - numbers done and results

Gillian Mostyn — Tue, 30 May 2017 22:04:30 GMT

Seriously... 10 years and under??? Even I offer bloods in many 10 year old cats ...and I certainly would in a 10 year old great dane!!

Missed the point completely.

RE: Pre-anaesthetic testing - numbers done and results

Neil Wheadon — Tue, 30 May 2017 21:09:45 GMT

Whenever Clive , as long as it's accurate.

It would be interesting to see how many of 21 years had a raised ALKP as I'm sure not every one was normal. It may also serve to re-assure as if a number of cases have an ALKP of say 300 and were still anaesthetised that may re-assure.

In essence until you ask the question you don't know anything do you?

Neil

RE: Pre-anaesthetic testing - numbers done and results

Clive Ansell — Tue, 30 May 2017 19:06:52 GMT

Do you mean the number done today? this month? this year?

In my 21 year career I can only think off hand of one significant case in a young outwardly healthy animal being admitted for routine surgery where pre op bloods yielded any useful information that altered the course of events. It was a 12 month old female Border Collie with a very low glucose level which turned out to have an insulinoma

RE: Pre-anaesthetic testing - numbers done and results

Neil Wheadon — Tue, 30 May 2017 18:51:56 GMT

OK , I don't want the normal, but mine was a 9 year old Weimeraner with an eyelid wart

I think you'll only see the results if you add something, no cheating!!