Pre-operative evaluation - Clinical management

Clinical management

Pre-operative evaluation

Surgery and anesthesia cause major perturbations to a patient’s homeostasis. The risk of potentially life-threatening complications can be reduced with appropriate pre-operative evaluation and therapy. Because cost concerns have virtually elim-inated pre-operative hospital admission, today the visit may occur just moments before the operation in the case of an emergency or a healthy outpatient, but is better managed in pre-anesthesia clinics to which patients report one or several days before their operation. Surgeons and primary-care physicians can do much to avoid operative delays and cancellations, as well as to reduce the patient’s cost and risk by identifying patients who need a pre-operative anesthesia consulta-tion and by sending all pertinent information, e.g., recent ECG, echo studies, etc., with the patient. The pre-anesthetic evaluation appears to be just another rou-tine of eliciting a history, reviewing all systems, performing a physical examina-tion, and checking laboratory studies. However, this traditional approach provides the structure that enables us to ferret out information that can affect anesthetic preparation and management. A widely accepted shorthand, the famous ASA Physical Status classification (Table 1.1), summarizes a thorough patient evalu-ation into a simple scheme, found on every anesthesia record. The six Physical Status classes do not address risk specifically, but do provide a common nomen-clature when discussing patients in general. That much more than the ASA physi-cal status classification need be known will become apparent from the following.