anesthesia for intracranial aneurysm surgery

1. Anesthesia for Intracranial Aneurysm Surgery Pekka O. Talke, MD

2. Aneurysms 2-5 % population 30K SAH/yr 2/3 get to hospital 1/3 in hospital severely disabled or dead Unruptured:1-2%/yr rupture Ruptured: 50% rerupture within 6 mo Urgent, not emergent cases Perioperative management of the geriatric surgical patients is becoming an increasingly important component of anesthetic practice in the 21st century. This phenomenon is due to the fact that people aged 65 years or older is the segment with the fastest growth in the population. It is estimated that by the year 2025, 20% of the U.S. population will be > 65 years of age . Currently, the elderly comprises one third of all operations being performed . Of those older than 65 years, one out of two will undergo an operation in their lifetime.Perioperative management of the geriatric surgical patients is becoming an increasingly important component of anesthetic practice in the 21st century. This phenomenon is due to the fact that people aged 65 years or older is the segment with the fastest growth in the population. It is estimated that by the year 2025, 20% of the U.S. population will be > 65 years of age . Currently, the elderly comprises one third of all operations being performed . Of those older than 65 years, one out of two will undergo an operation in their lifetime.

3. Surgeons Lawton Perioperative management of the geriatric surgical patients is becoming an increasingly important component of anesthetic practice in the 21st century. This phenomenon is due to the fact that people aged 65 years or older is the segment with the fastest growth in the population. It is estimated that by the year 2025, 20% of the U.S. population will be > 65 years of age . Currently, the elderly comprises one third of all operations being performed . Of those older than 65 years, one out of two will undergo an operation in their lifetime.Perioperative management of the geriatric surgical patients is becoming an increasingly important component of anesthetic practice in the 21st century. This phenomenon is due to the fact that people aged 65 years or older is the segment with the fastest growth in the population. It is estimated that by the year 2025, 20% of the U.S. population will be > 65 years of age . Currently, the elderly comprises one third of all operations being performed . Of those older than 65 years, one out of two will undergo an operation in their lifetime.

4. Anesthetic Goals Prevent aneurysm rupture (avoid hypertension) Decrease ICP (surgical exposure, retraction) Maintain CPP (>70 mmHg) Prevent cerebral ischemia from retraction Good operating conditions (NO movement, brain relaxation for exposure) In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

5. Patients, preop Symptomatic/asymptomatic Ruptured (SAH grade, myocardial effects), unruptured Possibly intubated Location and size of aneurysm Intracranial mass effect from SAH (increased ICP) Neurologic deficits and symptoms Timing, vasospasm In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

6. Preop One IV Premedicate with up to 2 mg of midazolam if normal mental status. Remind of potential post op intubation Adequate fluid loading (5 to 7 ml/kg of LR, angio) In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

7. Induction Routine monitors Propofol or thiopental Fentanyl 5 ug/kg in divided doses prior to intubation Muscle relaxant (roc). Arterial cannula before intubation Avoid hypertension (propofol) and hypotension (CPP, vasospasm) In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

8. Induction cont. Ceftriaxone 1 gm, 4-10 mg decadron, 1 gm/kg mannitol. Tape eyes with tagaderms (prep solution) Temp probe, foley Additional IV (limited access, 300 cc to liters of blood loss) Compression stockings In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

9. Positioning Supine, bump Long cases, lots of padding (pink and blue foam) Table turned typically 90 degrees Head down?, aeroplaning After draping minimal/no access to face (secure ET well) In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

10. Maintenance Oxygen Propofol infusion (50-200 ug/kg/min) (SSEPs, EEG) Inhalation agent (<0.25 MAC Isoflurane). Muscle relaxation (vec, panc) Moderate hyperventilation (ET CO2 30 mmHg) Euvolemia to 500 cc more (LR) Moderate hypothermia (34 oC) In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

11. Burst supression When requested by surgeon Thiopental 125 mg (5 cc) doses Till 70-80% EEG burst supression Redose as needed Turn fentanyl infusion off Reduce propofol infusion rate Support CPP with phenylephrine infusion In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

12. Clipping Temporary clips (golden) Permanent clips (silver) Aneurysm manipulation before clipping (bleed) Record clip on/off times Maintain CPP during temporary clipping Start closing, warming and more fluid loading after clipping In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

13. Toward the end First indication of end of surgery when clip aneurysm (60 min) Normalize CO2 once dura closed or earlier if lots of intracranial space Reduce propofol if possible, and titrate in labetalol In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

14. Toward the end cont. Turn propofol infusion off about 10 min before wakeup Reverse relaxation once Mayfied pins have been removed Attempt to wakeup patient. Unlikely if more than 1 gm of thiopental given. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

15. Recovery Wake patient up as soon as possible Extubate if possible Prevent post op hypertension (bleed). Labetalol Transport to ICU with monitor and oxygen Head up position In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

16. Potential Complications Delayed awakening from anesthesia Cerebral ischemia (retraction, temporary clips, vasospasm) Brain swelling Intraoperative hemorrhage In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

17. Aneurysm rupture Reasonably common Intubation, pinning, skin insicion, surgical manipulation Maintain intravascular volume (blood in the room, get help) Maintain CPP Adequate anesthesia Thiopental before temporary clipping In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

18. Vasospasm Only if SAH 5-14 days after SAH Leading cause of SAH morbidity (infarct) Maintain CPP at all times (neo infusion, volume) HHH therapy Consider CVP measurement In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

19. What�s new? Retractor pressure Temp control Normotension In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

20. Surgical Steps Mayfield pins (stimulation), head positioning Shaving/prepping/local anesthesia Skin incision (stimulation, blood loss) Scalp off the bone (most stimulation) Burr holes, sawing Removing bone Open dura Surgical approach to aneurysm (microscope, minimal stimulation, retraction) In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.

21. Surgical Steps cont. Burst supression Temporary clips, permanent clip(s) Close (60 min) Dura (water tight) Bone flap Scalp and skin Dressing, remove pins In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes. In order to optimize patient�s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.