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EVIDENCE BASED DATA
Year : 2007  |  Volume : 51  |  Issue : 1  |  Page : 65 Table of Contents     

Is routine pre-operative electrocardiogram necessary?


M.D., Sr. Prof. of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum - 590 010, India

Date of Web Publication20-Mar-2010

Correspondence Address:
P F Kotur
M.D., Sr. Prof. of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum - 590 010
India
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Source of Support: None, Conflict of Interest: None


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BEARs are the summary of the evidences pertaining to a specific clinical dilemma encountered in the day today anaesthetic practice. They are not the systematic reviews but rather contain the best evidence (highest level) available to any practicing anaesthesiologist. The search strategies adopted will not be discussed in detail


How to cite this article:
Kotur P F. Is routine pre-operative electrocardiogram necessary?. Indian J Anaesth 2007;51:65

How to cite this URL:
Kotur P F. Is routine pre-operative electrocardiogram necessary?. Indian J Anaesth [serial online] 2007 [cited 2020 Jul 8];51:65. Available from: http://www.ijaweb.org/text.asp?2007/51/1/65/61120

Though, electrocardiogram (ECG) monitoring has been included in the minimum mandatory monitoring guidelines, the advantages of routine preoperative screening of all the patients coming for surgery, has been questioned for over a long period of time. There is no absolute consensus as who should have a preoperative ECG.


   Evidences in support Top


There are several abnormalities detected on a 12 lead ECG which can significantly alter perioperative care. The most common ones are - arrhythmias, ST segment alterations, LVH, MI etc., which certainly can have impact on OT scheduling. Evidence to support preoperative ECG is imperfect because available studies differ in fundamental aspects. Not only are study designs variable, but investigators examine different end points viz., morbidity, anaesthetic intervention, case cancellation etc.

  1. A retrospective study of 3131 ASA class I and II patients who underwent surgery, revealed that 2406 had an ECG, of which 5-6% were unexpectedly abnormal; however anaesthetic management was altered in only 0-5% of patients. [1]
  2. In another retrospective study 1000 ASA I and II patients were evaluated as regards the efficacy of routine preoperative ECGs, before elective surgeries. Though the ECG was abnormal in 51% of patients with cardiovascular (CV) risk factors, there was no difference in prevalence of adverse perioperative CV events. [2]
  3. Based on data pooled from 16 studies, it was inferred that incidences of abnormalities on screening ECG exceeds 10% at 40 yrs of age and 25% by the age of 60 yrs and hence screening preoperative ECG are recommended in patients without apparent heart disease if they are between 40 to 50 yrs of age and if they are to undergo highly invasive procedure. [3]



   Evidences against Top


  1. Among 3,371 ECGs performed at hospital in 1981, at least 424 were done presumably for routine preoperative investigation. Analysing the data file of each patient, it was found that 14% had definitely abnormal ECGs of the type that generally implies IHD. Another 9% had ECGs that were possibly abnormal and needed, at least, a medical evaluation. However, only 22 out of 100 of those with abnormal ECGs, were eventually examined and of these, 9 had their management altered. These results suggest that routine preoperative ECG lacks the potential usefulness, given constraints present in several health centers in this country. [4]
  2. Routine preoperative ECGs are unnecessary in children unless there are clinical symptoms of heart diseases or heart disease is suspected. [5]
  3. Usefulness of ECG as a screening tool is quite limited because the resting ECG is normal in 50% of patients with chronic stable angina. [6]
  4. In a meta-analysis of long term survival of patients who had a resting ECG, it was inferred that there were insufficient data to advocate ECG as a screening test for coronary artery disease in asymptomatic patients or those with out any risk factors like diabetes, hypertension etc. [7]
Bottomline : Even though resting ECG lacks adequate specificity and sensitivity as a perfect screening tool, it has tremendous potential to detect diseases those can have impact on perioperative care in selected patients. The potential of preoperative ECG can be exploited if it is obtained in populations with high likelihood of cardiac disease. The physician must keep in mind that a test should not be ordered if it is unlikely to alter the patient's management…. [8]

Important clinical characteristics to consider preoperative ECG include: age more than 45 years, risk factors identified in PAE. diseases of CVS and RS and type or invasiveness of surgery. [9]

 
   References Top

1.PerezA, Plannel J Bacardaz C et al. Value of routine preoperative tests: A multicentric study in 4 general hospitals. Br J Anaesth 1995; 74: 250-56.  Back to cited text no. 1      
2.Tait AR, Parr HG, Tremper KK. Evaluation of the efficacy of routine preoperative electrocardiograms. J Cardiothoracic Vasc Anesth 1997;11(6):752-55  Back to cited text no. 2      
3.Roizen MF. Pre operative evaluation. In Miller RD(ed) Anesthesia ed 5. Philadelphia, Churchill Livingstone. 2000: 843-46.  Back to cited text no. 3      
4.Yipintsoi T, Vasinanukorn P,Sanguanchua P. Is routine pre-operative electrocardiogram necessary? J Med Assoc Thai. 1989; 72(1): 16-20.  Back to cited text no. 4      
5.von Walter J, Kroiss K, Hopner P, Russwurm W, Kellermann W, Emmrich P. Preoperative ECG in routine preoperative assessment of children Anaesthetist. 1998; 47(5): 373-78.  Back to cited text no. 5      
6.Braunwald E, Zipes G, Libby(eds), Heart Disease, ed 6 Philadelphia, WB Saunders. 2001: 1277.  Back to cited text no. 6      
7. Sox HC, Garber AM, Littenberg B. The resting electrocardiogram as a screening test. Ann Intern Med 1989; 111; 489-502.  Back to cited text no. 7      
8.Cohn SL, Goldman L. Preoperative risk evaluation and perioperative management of patients with coronary artery disease. Med Clin North Am 2003; 87(1): 111-36.  Back to cited text no. 8      
9.Eagle KA, Berger PB, Calkins H, Chaitman BR, EWY GA, Fleischmann KE et al. Practice advisory for Preanesthesia Evaluation Anesthesiology 2002; 96: 485-96  Back to cited text no. 9      




 

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