|Year : 2014 | Volume
| Issue : 1 | Page : 5-6
Preoperative evaluation: impact on anesthetic management
Mohamed Saleh, Yasser A Salem, Marwa A Khairy
Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
|Date of Submission||17-May-2013|
|Date of Acceptance||05-Jun-2013|
|Date of Web Publication||31-May-2014|
MD, Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain-Shams University, Abbasia, Cairo 11566
Source of Support: None, Conflict of Interest: None
Preoperative evaluation has a major impact on anesthetic management. Through a systematic approach of preoperative evaluation, involving history taking, physical examination, and preoperative investigation, the anesthetist could optimize patient's medical condition, determine a proper perioperative risk, develop an appropriate perioperative anesthetic plan, and improve quality for perioperative care.
Keywords: Assessment, evaluation, preoperative, visit
|How to cite this article:|
Saleh M, Salem YA, Khairy MA. Preoperative evaluation: impact on anesthetic management. Ain-Shams J Anaesthesiol 2014;7:5-6
|How to cite this URL:|
Saleh M, Salem YA, Khairy MA. Preoperative evaluation: impact on anesthetic management. Ain-Shams J Anaesthesiol [serial online] 2014 [cited 2021 Apr 19];7:5-6. Available from: http://www.asja.eg.net/text.asp?2014/7/1/5/128389
| Introduction|| |
The primary goals of preoperative evaluation are to document patient's condition before surgery, assess patient's general medical condition, and discover other hidden medical conditions. Aforementioned goals would allow anesthetist to optimize patient's medical condition, determine a proper perioperative risk, develop an appropriate perioperative anesthetic plan, and improve the quality of perioperative care .
Because of the importance of such topic, Association of Anesthetists of Great Britain and Ireland revised its safety guideline on preoperative assessment and patient preparation in 2010 . American society of anesthetists updated its practice advisory reports for preanesthesia evaluation in 2012 , which are valuable references for a practicing anesthetist. Preoperative evaluation consists of history taking, physical examination, and review of medical records.
| Patient history|| |
Patient history is the most important component of preoperative evaluation. Patient history should include detailed medical history with complete review of the systems, surgical history, special habits of medical importance, history of allergies, and current medications. In addition, anesthetist should address the issues directly related to perioperative management, including exercise tolerance, past experience with anesthesia, family history of problems with anesthesia, and history of difficult intubation .
Preoperative evaluation questionnaire is a simple and an effective way to collect such basic information. It permits minimization of the time spent during asking basic questions, allowing more time to discuss patient's actual problem and proposed operation. However, it should not be considered as a substitute for conventional preoperative evaluation ,.
| Physical examination|| |
The importance of preoperative physical examination cannot be overemphasized. Preoperative physical examination should include measurement of vital signs and airway, cardiac, and pulmonary examination. Other areas of physical examination may be important depending on the type of the procedure or patient's history, including neurological examination, examination of the site of regional blockade, or vascular access .
| Preoperative investigation|| |
Preoperative investigation should be ordered after patient's evaluation, and those relevant to that particular patient should only be requested. Anesthesiologist should keep in consideration patient's age, physical status, the extent of the planned surgery, and the presence of other comorbidity when ordering preoperative investigation . In fact, routine laboratory tests in patients who are apparently healthy on the basis of the history and clinical examination are invariably of little use and a waste of resources .
| Impact on anesthetic management|| |
Optimize patient's medical condition
Through meticulous preoperative evaluation, anesthetist can pick up medical conditions that might cause problems during perioperative period, optimize patient's medical conditions, ask for medical consultation, order specific investigation or intervention, and arrange appropriate level of postoperative care .
The aim of preoperative medical consultation is to treat an inadequately controlled chronic disease, to provide data to be used in anesthesia management (e.g. ischemic threshold of tachycardia on stress test), and to diagnose a previously undiagnosed medical condition .
Determine a proper perioperative risk
With a careful preoperative evaluation, a proper perioperative risk determination is possible. The American Society of Anesthesiologists (ASA) Physical Status classification is the most widely used system to predict perioperative risk. It assesses patient's overall physical state before administration of anesthesia or performing surgery. Although ASA Physical Status classification was originally not intended to predict perioperative risk, strong associations between ASA Physical Status classification and postoperative complications and outcome have been reported in the literature ,.
However, ASA Physical Status classification has its limitations. First, it is a subjective assessment of patient's overall health rather than an objective measure determined by the presence of specific disease states. Second, it does not take into account patient age, invasiveness of surgery, choice of anesthesia, the state of medical optimization, and the level of postoperative care. Third, ASA Physical Status does not differentiate between acute and chronic medical conditions and single and multiple systems affection. Furthermore, definition of systemic disease is unclear and creates a lot of confusion .
Develop an appropriate perioperative anesthetic plan
After meticulous preoperative evaluation, medical optimization, and proper risk determination, anesthetist should develop an anesthetic plan tailored to patient and procedure needs while insuring safe intraoperative course and postoperative outcome. Anesthetic plan should include premedication, monitoring, venous access, choice of anesthetic technique and drugs, airway and ventilatory management, fluid therapy, appropriate level of postoperative care, and postoperative analgesia. During development of anesthetic plan, anesthetist should weigh risks versus benefits to ensure that the best management is selected for the particular patient undergoing that surgical procedure. In addition to the anesthetic plan, plan B should always be available for crisis management, that is difficult intubation, anaphylaxis, local anesthetic toxicity, cardiac arrest, etc.
Improve quality for perioperative care
Inadequate preoperative evaluation, errors in patient preparation, and inadequate anesthetic planning are the most common causes of perioperative morbidity or mortality. Therefore, through aforementioned modalities, preoperative evaluation would have its effect in improving the quality of perioperative care. This could be measured in terms of reduction in patient's delay or cancellation on the day of operation, reduction in intraoperative and postoperative complications, reduction in hospital stay, and reduction in the hospital cost ,,.
| Acknowledgements|| |
Conflicts of interest
| References|| |
|1.||Zambouri A. Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia 2007; 11:13-21. |
|2.||Verma R, Wee MYK, Hartle A, Alladi VR, Rollin A-M, Meakin G, et al. Pre-operative assessment and patient preparation. The role of the anaesthetist. AAGBI Safety Guideline (2010). Available at: http://www.aagbi.org/sites/default/files/preop2010.pdf">http://www.aagbi.org/sites/default/files/preop2010.pdf [Accessed on 2013 May 15]. |
|3.||Apfelbaum JL, Connis RT, Nickinovich DG, Pasternak LR, Arens JF, Caplan RA, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 2012; 116:522-538. |
|4.||Sweitzer BJ. Preopertive evaluation and medication. In: RD Miller, M Pardo, RK Stoelting, (editors). Basics of anesthesia. Philadelphia, PA: Elsevier/Saunders; 2011. 165-188. |
|5.||Garcia-Miguel FJ, PG Serrano-Aguilar, J Lopez-Bastida. Preoperative assessment. Lancet 2003; 362:1749-1757. |
|6.||Ladfors MB, Lofgren ME, Gabriel B, Olsson JH. Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 2002; 81:437-442. |
|7.||Preoperative tests. The use of routine preoperative tests for elective surgery. Available at: http:// www.nice.org.uk/nicemedia/pdf/preop_fullguideline.pdf [Accessed on 2013 May 15]. |
|8.||Shah SA, Sajid T, Asif M, Khan F, Ghani R. Significance and cost effectiveness of pre-operative routine laboratory investigations in young healthy patients undergoing elective ear, nose & throat surgery. J Ayub Med Coll Abbottabad 2007; 19:3-6. |
|9.||Wijeysundera DN. Preoperative consultations by anesthesiologists. Curr Opin Anaesthesiol 2011; 24:326-330. |
|10.||Lubarsky D, K Candiotti. Giving anesthesiologists what they want: how to write a useful preoperative consult. Cleve Clin J Med 2009; 76:S32-S36. |
|11.||Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996; 77:217-222. |
|12.||Daabiss M. American Society of Anaesthesiologists Physical Status classification. Indian J Anaesth 2011; 55:111-115. |
|13.||Benn J, Arnold G, Wei I, Riley C, Aleva F. Using quality indicators in anaesthesia: feeding back data to improve care. Br J Anaesth 2012; 109:80-91. |
|14.||Haller G, Stoelwinder J, Myles PS, McNeil J. Quality and safety indicators in anesthesia: a systematic review. Anesthesiology 2009; 110:1158-1175. |
|15.||Lagasse RS. Indicators of anesthesia safety and quality. Curr Opin Anaesthesiol 2002; 15:239-243. |