Pre-anaesthetic checkup In India: A review

Pre-anesthesia checkup (PAC) has been defined as the process of clinical assessment that precedes the delivery of anesthesia for surgical and nonsurgical procedures. The primary purpose of this endeavor is to assess, known and diagnose unknown co-morbidities which directly or indirectly affect the perioperative management of the patients. In India, there are no national guidelines available for this like those commonly seen in the west. The lack of guidelines and the ‘open to interpretation’ approach, in our view, lead to the overuse of unnecessary investigations. Most of the western guidelines focus primarily on a comprehensive patient interview and a thorough physical examination in the PAC. There is a dearth of data delineating the practice of ordering preoperative tests for patients undergoing routine elective surgery in India. If routine laboratory testing would detect a sufficiently high number of patients with comorbid conditions that alter perioperative management, then its use may be justified. In such a case it may also hold as a valid defense in the court of law in case of litigation. However, studies from across the globe including India show that detection rates from routine testing are extremely low. In studies from the Indian subcontinent, a clear evidence of abnormal findings on routine testing that may impact management has not been found. In this article, we try to explore the current practices regarding PAC in India and attempt to make recommendations for the establishment of national guidelines.