THE OSTIA VENAE HEPATICAE AND THE RETHROHEPATIC ...

166 Faculty of Medicine Siriraj Hospital
WHEN SHOULD WE ORDER PREOPERATIVE BLOOD GLUCOSE, BUN,
CREATININE, OR ELECTROLYTES? : A SYSTEMATIC REVIEW AND
CLINICAL PRACTICE GUIDELINES
Santawat U 1 , Lertakyamanee J 1 , Neti T 2 , Somprakit P 1 , Chulajata D 2 , Tritrakan T 2 , Soontranan
P 2 , Piti-manaaree S 2 , Vasuvattakul S 3 , Yamwong P 4
1 2 Department of Anesthesiology and Clinical Epidemiology Unit, Department of Anesthesiology,
3 4 Department of Medicine, Department of Preventive and Social Medicine, Faculty of Medicine
Siriraj Hospital, Mahidol University.
Key words : preoperative investigation, systematic review, blood chemistry
Objectives of the study were to apply a systematic review to answer the question whether
routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines
for preoperative checking of blood glucose, BUN, creatinine and electrolytes. The guidelines were prepared
for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline
search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability
were applied to paper selection. The results of the systematic review were discussed among
anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the
systematic review suggested there were no randomized controlled trials to answer the question and no
studies reported health outcomes. From this review and the consensus, we proposed guidelines which
consisted of history questionnaire, physical examination and indications for investigation. For the
preoperative checking of blood glucose, the indications were: age ³ 60 years, obesity, diabetes,
hypoglycemia, liver disease, alcoholism, severe infection, alteration of consciousness, hypothalamic,
pituitary, pancreatic and adrenal disease, and steroid therapy. The common indications for both BUN/
creatinine and electrolytes checking were: age ³ 60 years, undergoing TURP, TUR-BT and major KUB
surgery, obesity, diabetes, hypertension, chronic renal failure, renal disease, liver disease, alcoholism,
severe infection, severe vomiting or diarrhea, history of fluid, acid base or electrolyte disturbance, alteration
of consciousness, hypothalamic, pituitary, pancreatic and adrenal disease, ADH abnormality and
diuretic or digoxin therapy. The additional indications for electrolyte checking were: convulsion or
muscle weakness, CNS disease with increased ICP and steroid therapy.
(Siraj Hosp Gaz 1999; 51: 779-90)
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