Pre Anaesthetic Check up  (aka- PAC) – Fitness for Anesthesia

For surgeons to operate on us, we need to sleep so that they can operate without we moving our body. Also it is important that we should not be experiencing pain. Both these requirements need anaesthesia (medical sleep). To achieve this medical sleep, the anaesthetist gives drugs to make the brain go into a state of unconsciousness and when the drug antidote is given, the effect is reversed. The recovery from anaesthesia is also dependent on the excretion ( removal) of these drugs through lungs and kidneys!

So we are expected to undergo a battery of investigations depending on our age, and the complexity of surgery. These group of tests are called SURGICAL PROFILE. It usually consists of investigations that will evaluate your Hemoglobin levels (reflect blood oxygen carrying capacity), tests to evaluate your kidneys, lungs and sometimes even your heart functional reserve.

Functional reserve means, the  excess capacity  of function (of the organ) available in case of increased demand. For Eg. the resting heart rate is 70-80 per minute and it raises to 100-150 when the individual starts running, an act that demands increased heart pumping. The breathing rate doubles or even triples in the state of running to meet the increased demand for oxygen.

A basic surgical profile will test lungs, kidneys and heart function, as these are important for any form of anaesthesia. It is important to realize that when ever a patient is put under anesthesia, the drugs used, will push the heart and lungs to function at a higher pace while the kidneys are important to excrete the drugs used for anesthesia. So these tests will evaluate the organs ability to endure the higher demand put by anaesthesia. When the values for these tests are within normal limits ( eg: creatinine 0.2 -1.2 mg/dl )means excretory capacity of the kidney is good and can be expected to excrete the drugs in time. Values of lung (Respiratory rate, Pulmonary function tests) or heart function tests ( Pulse rate, Blood Pressure, 2D Echo, ECG & Stress test)  if exceed the normal range indicates, their functional capacity is less even in the resting phase and hence there is a higher chance of failing when stressed during surgery.

The extent of the testing is estimated based on the age of the patient ( higher the age, greater the chance of reduced reserve – hence more intensive testing) and complexity of the surgery – as complex surgeries will be of longer duration, with possible increased risk of blood loss, and could be cause for physiological disturbance (Eg. removal of lung reduces lung reserve).

So surgical profile is a very important step for assessing the risk of surgery for a particular patient. It is very important that we make a educated analysis for the the tests being done, rather than falling for the media influenced biases against the medical community in general.

A caution: All the tests done, assessments made, as of today, give the treating physician, a calculated estimate of the  probable functioning and the behaviour of the organ and the patient’s body in the time of stress.

It is important for us to focus on the words Calculated & probable which indicate very clearly the limitations of healthcare science as of today!

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