Which preoperative screening investigations are required for outpatient anaesthesia?

The volume of preoperative screening investigations for outpatient anaesthe sia ranges from few, selectively ordered investigations to extensive routin e diagnostic procedures. It seem appropriate to reevaluate benefit and effi cacy of routine preoperative assessment programs. The purpose of preoperati ve diagnostic is to assess the risk of anaesthesia and surgery for the pati ent. As shown by a number of studies, preoperative screening investigations seldom disclose new pathological findings of clinical relevance. Abnormal laboratory results in otherwise healthy patients rarely alter the anaesthet ic management of the patient and are not related to perioperative complicat ions. Extensive use of costly diagnostic procedures considerably increases health care budgets. A more selective approach to order preoperative invest igations promises considerable savings. To achieve costeffective evalulatio n an efficient organisation of properative assessment must be established t o avoid costly delay and on-day-of-surgery-canceIlations. There is no medic olegal obligation to perform routine diagnostic testing. The anaesthetist m ust be sufficiently informed in time to assess the perioperative risk of th e patient and to alter anaesthetic management as necessary. According to th e presented studies a clinical history and a thorough physical examination represent an effective method of screening for the presence of disease. Car eful medical history evaluation and physical examination can avoid extensiv e investigations in apparently healthy individuals and the latter should on ly be ordered if indicated.