This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bryson, G. Search for Related Content PubMed Articles by Bryson, G.

REPLY

The Ottawa Hospital, Ottawa, Canada, E-mail: glbryson{at}ohri.ca

I thank Dr. Hamilton for his interest in the articles recently published in the Canadian Journal of Anesthesia, and congratulate him on his efforts to standardize preoperative testing across the Interior Health Authority of British Columbia.

The National Institute for Health and Clinical Evidence (NICE) guideline is, on the whole, an excellent choice for institutions wishing to standardize their preoperative testing procedures. I would like to raise a few minor concerns for institutions considering adopting these guidelines. First, thyroidectomy, lumbar discectomy, and transurtheral prostatectomy are considered major surgery in NICE recommendations. In many institutions these procedures are performed as day surgery and would, therefore, not be considered "major". Second, depending on the circumstances, the NICE guideline leaves up to 50% of testing decisions to be considered by the ordering physician. While leeway for clinical judgment is laudable, a guideline with this degree of flexibility may be difficult to standardize across institutions. Lastly, publication of 38 separate tables was required to incorporate ASA class, severity of surgery, and comorbidity in the NICE recommendations. Concerns regarding physician attention-span aside, the tests indicated (and contraindicated) under the NICE guideline are appropriate and should reduce unnecessary testing. Adoption of these guidelines, tempered by knowledge of local surgical practice, would represent a significant step forward for most institutions.

The NICE publishes a wide variety of well-researched and coherent guidelines relevant to perioperative care. Recent guidelines on the use of ultrasound for central venous cannulation¹ and fluid resuscitation in trauma² may also be of interest to Canadian anesthesiologists.

References

1 National Institute for Clinical Excellence. Technology Appraisal Guidance - No. 49. Guidance on the use of ultrasound locating devices for placing central venous catheters. Available from URL; http://www.nice.org.uk/pdf/ultrasound_49_guidance.pdf. Issue date: September 2002, Review date: August 2005. Accessed October 2005.

2 National Institute for Clinical Excellence. Technology Appraisal 74. Pre-hospital initiation of fluid replacement therapy in trauma. Available from URL; http://www.nice.org.uk/pdf/ta074guidance.pdf. Issue date: January 2004. Accessed October 2005.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bryson, G. Search for Related Content PubMed Articles by Bryson, G.