Which of the following screening tests are important for preoperative evaluation of pulmonary function?

A. History and physical examination.

B. Room air arterial blood gases.

C. Chest film.

D. Vital capacity and forced expiratory volume in 1 second (FEV 1).

E. Cardiopulmonary exercise testing.

DISCUSSION: The most important clues to impairment of respiratory function are found in the history and physical examination. A negative history and physical examination in combination with a relatively normal room air arterial blood gas and normal chest film are sufficient to screen patients to support the clinical impression that there is minimal pulmonary disease. Patients with symptoms, positive physical findings, and/or abnormalities in the arterial blood gases or chest film can be screened most effectively with an additional evaluation of the vital capacity and FEV 1. More elaborate tests such as cardiopulmonary exercise testing are reserved for patients with obvious and marked impairment of pulmonary function who are being evaluated for the feasibility of surgical intervention.