Preanesthetic Evaluation of the Surgical patient

1
Preanesthetic Evaluation of the Surgical patient

• ??? R3 ? ? ?

2
I. Preoperative Assessment of surgical patient
for anesthesia

• issue of appropriate preopeative preparation
• ambiguous and frustrating
• surgical procedure performed with anesthesia
  assistance require some form of preanesthetic
  evaluation
• anesthesia is greater risk than surgery itself
• preanesthetic process affect clinical safety and
  organizational integrity
• appropriately prepared patient prevents clinical
  morbidity

3
II. Cause of simple process to become more complex

• surgeon vs. anesthesiologist
• selection of procedure
• process control
• preoperative evaluation uint
• no consistent system for risk assessment
• multiple professional society

4
III. Preanesthetic evaluation

• portion of general process of preoperative
  evaluation
• preanesthetic activity
• enhance safety, comfort, efficiency of process
  for patient and clinical staff
• focus
• safe anesthesia and performance of surgery
• acute or chronic medical condition
• refer to their primary care provider or
  organization

5
IV. Risk classification ( 1 )

• Saklad's system
• Meyer Saklad, 1941
• first attempt to stratify risk for patient
• type of anesthesia and nature of surgery are not
  consideration
• four preanesthesia risk category ( ASA PS 1-4 )

6
IV. Risk classification ( 2 )

• American Society of Anesthesiologists system
• modified Saklad's system
• add fifth category
• limited application
• table - 1

7
(No Transcript)
8
IV. Risk classification ( 3 )

• Johns Hopkins Risk Classification System (JHRCS)
• evaluate preoperative medical condition and
  nature of surgery as independent
• nature of surgery is major determinant of risk
• table 2

9
(No Transcript)
10
V. Patient and Procedure Selection

• change in surgical technology, perioperative
  care, and postoperative management
• preoperative admission
• outpatient procedure
• Discharge

11
VI. Time of Evaluation

• common assumption
• utility of preoperative evaluation before the day
  of surgery is scant and inconclusive
• Twersky - evaluate on day of surgery

12
VII. Personnel performing the Evaluation

• anesthesiologist
• retain all preanesthetic interview responsibility
• directly involve with patient's care and ensure
  appropriate information
• assessment of patient with significant medical
  problem
• not performed by anesthesiologist
• provided by patient's primary care provider
• standard form for review ( table - 3 )
• time of assessment ( table 4)

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
VIII. Laboratory Testing ( 1 )

• costly issue associated with surgery
• cost of care and convenience of patient is major
  concern
• key consideration for relevant to anesthesia
• anesthesia is safety condition
• prevalence of condition in both symptomatic and
  asymptomatic patient
• test sensitivity and specificity
• Cost

17
VIII. Laboratory Testing ( 2 )

• reasonable test
• positive finding in history and P/E
• need for baseline value in anticipation of
  significant change due to surgery and medical
  intervention
• patient's inclusion in population at higher risk

18
(No Transcript)
19
IX. Communication

• appropriate determination of
• patient medical status and laboratory test
• surgeon, all practitioners operate