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Preoperative Evaluation/Patient Issues/Pregnancy testing before surgery

QUESTION:

Is pregnancy testing necessary for EGD/Colonoscopy on female patients?

-- From Mahendra Shah, M.D., Trenton, NJ

REPLY:

The practice of routine preoperative testing has been under constant review and revision with current practice tending toward more focused testing driven by the patient's coexisting physiologic disease states, and how information gained would alter the course of an anesthetic. The question becomes in early term pregnancy how would a positive pregnancy test change the management of the anesthetic? In our literature, there is currently no scientific data to support that any anesthetic drug can harm an early human pregnancy. Furthermore, the ASA Committee on Ethics has written that the "State of pregnancy is very personal information that belongs to the patient, and it does not alter her right to proceed with anesthesia and surgery if she so desires. Therefore, pregnancy testing should be offered to patients but should not be required by physicians unless there is a compelling medical reason to know whether the patient is pregnant." They continue, "The Committee on Ethics maintains that a blanket policy of non-consented testing for pregnancy cannot be ethically justified. Beyond not being ethical, it also may not be legal to test a patient for pregnancy without her consent."(1) So, if the provider or patient has a high index of suspicion then pregnancy testing should be offered, but as to being necessary or routine, the current scientific and ethical evidence would not support that opinion.

References:
(1) Palmer, S., Jackson, S. "What's New in Ethics, Hot Issues in Legally Sensitive Times", American Society of Anesthesiologists Newsletter, Oct 2003, Number 10, Volume 67,

-- From John Frenzel, M.D., Houston, TX


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