When should we order preoperative blood glucose, BUN, creatinine, or electrolytes: A systematic review and clinical practice guidelines.

The study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative checking of blood glucose, BUN, creatinine and electrolytes. The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review suggested there were no randomized controlled trials to answer the question and no studies reported health outcomes. From this review and the consensus, we proposed guidelines which consisted of a history questionnaire, physical examination and indications for investigation. For the preoperative checking of blood glucose, the indications were: age > 60 years, obesity, diabetes, hypoglycemia, liver disease, alcoholism, severe infection, alteration of consciousness, hypothalamic, pituitary, pancreatic and adrenal disease, and steroid therapy. The common indications for both BUN/creatinine and electrolytes checking were: age > 60 years, undergoing TURP, TUR-BT and major KUB surgery, obesity, diabetes, hypertension, chronic renal failure, renal disease, liver disease, alcoholism, severe infection, severe vomiting or diarrhea, history of fluid, acid base or electrolyte disturbance, alteration of consciousness, hypothalamic, pituitary, pancreatic and adrenal disease, ADH abnormality and diuretic or digoxin therapy. The additional indications for electrolyte checking were: convulsion or muscle weakness, CNS disease with increased ICP and steroid therapy.

Renal transplantation in Thai children.

Renal transplantation in children has been performed for over 25 years in developed countries but has never been reported in Thai children. We report an 8 year-old girl with end-stage renal disease due to chronic glomerulonephritis who had been transplanted at Siriraj Hospital. She was treated with continuous peritoneal dialysis for 9 months and developed several episodes of bacterial peritonitis and hypertension. She was transplanted using her father’s kidney and her serum creatinine level was normal within 7 postoperative days. The patient developed severe hypertension which was controlled with 4 antihypertensive agents. Five weeks postoperation her new ureter leaked. Although surgery was performed with internal stent placed, the patient continued to have urinary leakage and ureteric reconstruction using bladder flap or her own ureter will be done later. The patient’s renal function was normal on follow up.