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Laboratory investigations should not be ordered routinely as part of the preoperative evaluation. Laboratory and diagnostic investigations should be ordered only when indicated by the patient’s medical comorbidities, drug therapy, or nature of the proposed procedure. The 2011 Canadian Anesthesiologists’ Society (CAS) Guidelines to the Practice of Anesthesia offers suggestions to guide preoperative testing (Table 3.6).

In 2007, the American College of Cardiology and the American Heart Association (ACC/AHA) revised their guidelines on perioperative cardiovascular evaluation and care for patients undergoing noncardiac surgery.¹ Fig. 3.1 illustrates the ACC/AHA algorithm that can be used to guide investigation and management of patients with cardiovascular disease undergoing noncardiac surgery.