[Preoperative evaluation and preparation. The view of the anesthetist]

Besides other reasons, cost containments mandate the rational use of preoperative screening tests which should be adapted to the risk of the individual patient. Since the perioperative cardiac risk increases with age, elderly patients in particular require a thorough evaluation of their perioperative risk. Routine ECG, however, is not indicated in patients under 45 years of age who do not present with signs or history of preexisting cardiac diseases but should be performed on a routine basis in all patients over 45 years of age. The validity of an ergometer test as a preoperative indicator of myocardial ischemia is limited due to high incidence of false negative results. By preoperative routine chest radiography previously unknown findings are only detected in a small number of patients; thus, in patients of ASA-risk groups I-II younger than 74 years of age routine chest-x-ray cannot be justified. In patients whose perioperative cardiac risk as assessed clinically and by ECG is ambiguous, dipyridamole-thallium-myocardial scintigraphy (DTMS) and dobutamine-stress-echocardiography may contribute valuable information regarding the prediction of perioperative adverse cardiac events. In that respect, dobutamine-stress-echocardiography appears to be superior to DTMS. The laboratory tests required in patients of different ASA-risk groups and according to their age are presented in an overview.