Anesthesiologists told: Question 5 procedures
Proving that less really is more, five specific tests or procedures commonly performed in anesthesiology that might not be necessary and, in some cases should be avoided, was published online June 16 in JAMA Internal Medicine.
The "Top-five" list was created by the American Society of Anesthesiologists (ASA) for inclusion in the ABIM Foundation’s Choosing Wisely campaign.
"The top-five list of activities to question in anesthesiology was developed in an effort to reduce unnecessary, costly procedures and improve patient care," said Onyi Onuoha, MD, MPH, lead author and assistant professor of the Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania in Philadelphia. "The Choosing Wisely list can help patients and doctors save time, money, and prevent possible harm by avoiding medical treatments or tests that may not be required."
Items were restricted to common preoperative and intraoperative practices in anesthesia. Anesthesiologists identified the following five recommendations:
1. Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery, specifically, complete blood count, basic or comprehensive metabolic panel, and coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.
2. Don’t obtain baseline diagnostic cardiac testing (trans-thoracic/esophageal echocardiography [TTE/TEE]) or cardiac stress testing in asymptomatic stable patients with known cardiac disease (e.g., CAD, valvular disease) undergoing low- or moderate-risk non-cardiac surgery.
3. Don’t use pulmonary artery catheters (PACs) routinely for cardiac surgery in patients with a low risk of hemodynamic complications (especially with the concomitant use of alternative diagnostic tools, e.g., TEE).
4. Don’t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable.
5. Don’t routinely administer colloid (dextrans, hydroxylethyl starches, albumin) for volume resuscitation without appropriate indications.