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This is because, surgery is always associated with some risk for the patient, both due to the procedure and due to the anesthesia administered for the procedure. Whatever be the level of risk, due to medico-legal implications, every anesthetist performs a detailed evaluation of the patient prior to shifting to operating room. Evaluation includes detailed history taking pertaining to the present disease, past diseases, medications that the patient is taking, known allergies to any drugs, family history of any significant health ailments and personal history like drugs, alcohol and smoking. Evaluation also includes review of previous investigations, detailed physical examination and laboratory testing. In many parts of the world there are protocols for routine laboratory testing like complete blood picture, serum electrolytes, BUN and creatinine, liver function tests, urine analysis, chest X-ray and electrocardiogram (Garcia et al, 2003). However, there are reports and more and more studies are pointing to the fact that these routine investigations have no role in ascertaining fitness for surgery in otherwise healthy individuals posted for elective surgery. The experts are of the opinion that investigations must be considered only on individual basis because; the percentage of abnormal reports from the tests are minimal and even when abnormalities are detected is no change is done in the perioperative management of the surgical patient. Another important aspect of routine testing is that it does not stratify and predict perioperative complications (Narr et al, 1997), thus, defeating the very purpose of preoperative testing. They are also costly and add to health care (Narr et al, 1991). In this review, the impact and clinical outcomes of preoperative screening investigations in otherwise healthy individuals posted for elective surgery will be discussed through review and critical analysis of suitable literature. Aim The main aim of the study is to ascertain the outcome of routine preoperative testing in otherwise healthy individuals for elective surgeries. Objectives The objectives are to study the impact and outcomes of routine preoperative testing in terms of change in case management based on abnormalities, percentage of abnormalities identified, cost to patient and health care system, iatrogenic injury and to understand guidelines for preoperative testing in healthy subjects. Materials and methods To find pertinent literature studies, the initial literature searches progress was conducted in the various databases, Blackwell-Synergy, CINAHL, CMJA, Cochrane, EMBASE, Health Reference Center Academic, Internures, MD Consult, Mosby’s Nursing Consult, Proquest5000 and ScienceDirect. It was found that numerous articles were available. In order to further analyse manageable number of the quality and acceptability of the research articles, inclusion criteria were conducted in the following search strategy. The applicable key terms were combined with using thesaurus, truncation, Boolean operators and other limit, such as a language, subject fields of journal and years of publication in the search strategy. For example, “preoperative”, “preop”, or “screening for surgery” combined with “investigations”, “laboratory tests”, “tests”, or “assessment” as title and text words were utilised in the search strategy. Also, it includes studies published from 1985 to 2011, health, medicine and nursing fields and English language articles. Thus, several relevant
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Chapter 1: Introduction
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Moreover, the psychological condition of the patient plays a vital role in the success of a surgery (Janis, 1958). This is why it is very important to measure and research on preoperative anxiety. Patients are usually quite worried about the success of their surgery, anxious about anesthesia and the pain they would have to bear once the surgery has been done and their concerns make them anxious.
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As a result, and vise versa, as an immediate consequence of this catastrophic disaster for the whole nation, Sayyid Ruhollah Mostafavi Musavi Khomeini, a prominent leader of the Islamic Revolution, became the Supreme Leader, 'Grand Ayatollah,' of Iran, until his death, 1989 (Joseph, 2000).
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28 Pages(7000 words)Dissertation
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