Radical changes in medicine in recent decades have brought about substantial changes in the specialties. Technological and scientific advances now make it possible to perform interventions and procedures that previously could not be solved by surgery or were declared out of therapeutic reach.
Preoperative assessment has become more relevant in the last decade, mainly due to the following facts:
- The increase in the number of elderly patients
- The rise of outpatient surgery
- The development of technology, which enables diagnostic and therapeutic procedures to be
Out-of-cell therapy, requiring sedation or anaesthesia
- Very complex and long-term surgeries, in compromised patients
- The need for cost containment
ENT surgeons perform hundreds of more common procedures such as removal of tonsils and adenoids, repair of perforations in the eardrum (tympanic membrane), functional nose surgery, sinus surgery. They also perform highly complex surgeries, such as endoscopic surgery to remove sinus tumours, micro laryngoscopy for laryngeal tumours, microsurgery for acoustic neuroma. Mastoidectomy for removal of ear tumours.
ENT specialists offer a full range of diagnostic evaluations, medical treatment and surgical services and procedures.
But there is a common factor for all these procedures, such as laboratory, imaging, cardiovascular and anaesthesiology examinations.
Every patient undergoing ENT surgery should have a blood test.
After puncturing a vein, usually in the arm (at the bend of the elbow), blood is collected in container tubes to evaluate the results of the different groups of parameters that can be requested. There are tubes for haematology, biochemistry, coagulation, ESR (erythrocyte sedimentation rate) and for different culture media. The tubes contain an anticoagulant to prevent the blood from clotting during transport to the testing laboratory. And usually about 10 millilitres of venous blood is drawn for each tube.
The patient does not need any special preparation. The blood test is usually carried out after fasting for at least six hours, as food intake alters numerous biochemical parameters such as glucose, triglycerides, etc. Apart from the venous puncture, which some patients find unbearable, others painful, and most find uncomfortable at most, a haematoma sometimes develops at the puncture site.
With the technique of compressing the puncture site for about one minute, the likelihood of one of these bruises is minimal. The possibility of error in the identification of the blood sample is now virtually non-existent, thanks to the labelling of the tubes with barcodes.
Request for different parameters
Among the most commonly requested parameters in blood analysis are blood count, blood biochemistry, coagulation tests, concentrations of various mineral ions, hormone determinations, and the determination of the presence of antigens of micro-organisms of infectious diseases and the antibodies produced by the body against these antigens.
In addition, specific determinations can be performed to study different types of diseases or lesions of different organs, for example:
- Haemogram. It includes the determination of the parameters of the red series or red cells (red blood cells), platelets, and the leukocyte formula or percentage of each type of white blood cell in the blood.
- Liver tests. This includes the determination of transaminases GOT and GPT, ALP (alkaline phosphatase), GGT (gamma glutamyltranspeptidase), bilirubin and, in the case of suspected hepatitis, determination of viral antigens and antibodies to these antigens.
- Renal function. Includes determination of urea, creatinine, sodium, potassium, cholesterol, triglycerides, calcium, phosphates and creatinine clearance.
- Diabetes test. It includes the determination of blood glucose, HbA1c (glycosylated haemoglobin), total cholesterol, HDL-c ("good" cholesterol), LDL-c ("bad" cholesterol), triglycerides and creatinine.
- Hypertension study. Includes determination of blood glucose, creatinine, total cholesterol, HDL-c, LDL-c, sodium, potassium, uric acid.
- Dyslipidaemia study. Includes the determination of total cholesterol, HDL-c, LDL-c, triglycerides, VLDL and total lipids.
- Study of osteoporosis. Includes determination of blood count, liver and kidney function, calcium and phosphorus.
- Anaemia study. Includes a complete blood count, iron, ferritin, reticulocytes, folic acid, vitamin B12, total bilirubin, haptoglobin, direct Coombs' test.
- Thyroid study. Includes determination of TSH, free T4, T3, antithyroglobulin and anti-TPO antibodies.
- Coagulation study. Includes determination of platelet count, TTP (activated partial thromplastin time) and Quick's time.
- Arthritis in adulot and immunological study including determination of ESR (erythrocyte sedimentation rate), ASTO (antibody detection test IMG and IGA against the antigen called streptolysin O produced by a large positive coccus called streptococcus pyogen), CRP (C-reactive protein), RF (rheumatoid factor), VDRL and AIDS.
Diagnostic imaging is an essential element in the assessment of many ENT disorders. Computed tomography (CT), chest X-ray and magnetic resonance imaging (MRI).
Depending on the cardiac condition, posteroanterior, right oblique and left oblique views should be requested, although there are no controlled trials on the efficacy of systematic chest radiography. It is necessary to recognise the pulmonary aeration status and to determine pulmonary alterations in both diaphragms. It is necessary to relate the images to the signs and symptoms reported by the patient.
- Preoperative chest teleradiography should be requested for all subjects scheduled for cardiac surgery.
To evaluate ENT pathology, CT scans of the paranasal sinuses, CT of the middle ear and mastoids are frequently requested.
MAGNETIC RESONANCE IMAGING
We request it to evaluate the soft parts of the ear, nose, neck and oropharynx organs.
Preoperative cardiovascular study
The goal of preoperative cardiovascular assessment is to systematically use surveillance and monitoring mechanisms with the patient in order to reduce risk and optimise surgical outcome. It is important to know from the most obvious details of the current condition to factors that may seem insignificant, such as the "naturopathic" drugs taken by the patient, as these "minor" details can make a difference in the final outcome.
It is an essential test for the diagnosis of basal rhythm, in addition to the diagnosis of arrhythmias, ischaemia and repolarisation disorders that affect prognosis.
- A preoperative 12-lead resting electrocardiogram is required for all patients scheduled for ENT surgery.
Technological advances in medicine in recent decades have made it possible to perform interventions on patients who were previously beyond the reach of surgery. The pre-anaesthetic assessment is the responsibility of the anaesthesiologist and considers information from multiple sources: medical history, interview, records, physical examination and tests.
It allows to know the patient's history, identify modifiable risk factors and develop an anaesthetic plan in relation to the findings to reduce peri-operative morbidity and mortality; to educate, improve patient satisfaction and reduce anxiety; to avoid unnecessary delays or suspensions; to coordinate inter-consultations if the patient requires it; and to carry out an informed consent process with the patient's signature.