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BASIS OF ASSESSMENT

Basic cardiopulmonary resuscitation (CPR) begins with a patient assessment (Annie are you OK, check breathing, pulse check) which determines if and which treatment is needed. Following treatment, reassessment is performed. An automatic external defibrillator (AED) assesses the patient’s electrocardiogram (ECG) before delivering a shock if needed. Anesthesia patient care also follows this sequence of assessment, treatment, then reassessment. The primary agent for assessment is the health care provider, who may use tests, devices, or monitors to aid the assessment. The American Society of Anesthesiologists (ASA) has affirmed standards for basic anesthetic monitoring during general anesthetics, regional anesthetics, and monitored anesthesia care. The first standard requires qualified anesthesia personnel to be present in the room continuously to assess and treat the patient during these procedures. “Continuous” is defined as “prolonged without any interruption at any time” while the term “continual” means “repeated regularly and frequently in steady rapid succession.” An arterial line can provide continuous systemic blood pressure monitoring while an automated blood pressure cuff set at 5-minute intervals can provide continual blood pressure readings.

The depth and methods of a circulatory system assessment depend on the situation. In a “code blue” setting, a pulse check provides decisive initial information. Differing assessment techniques can be available in the preoperative, intraoperative, and postoperative periods. A 12-lead ECG is a common preoperative and postoperative assessment tool but is rarely performed intraoperatively. Selected leads (see Chapter 13) are monitored intraoperatively to reveal ischemia or injury in the areas of the heart most likely to be affected in that individual.

PREOPERATIVE CIRCULATORY SYSTEM ASSESSMENT

Before any surgery or procedure that requires the presence of anesthesia personnel, a preoperative anesthesia evaluation is performed. This evaluation consists of a history and physical exam comprising inspection, palpation, and auscultation. The history obtained from the patient and previous medical records reveal the presence (or absence) of circulatory system conditions that warrant further investigation. The physical examination can confirm the presence of these conditions or reveal previously unrecognized circulatory system disease.

This evaluation includes each of the three components of the circulatory system: the heart, the vessels, and the blood. Abnormal findings in any of these components can require deeper questioning of the patient and further chart review. Preoperative anesthesia circulatory system assessment can include appropriate consultations and indicated radiologic, ECG, or laboratory tests including hemoglobin, hematocrit, and coagulation studies. Perioperative anesthesia care focuses on short-term provision of adequate tissue perfusion while reducing long-term morbidity and mortality.

PREOPERATIVE CARDIOLOGY CONSULTATION

The extent and invasiveness of cardiovascular system assessment is affected by clinical specialty, clinical situation, and patient factors. Consultation of the cardiologist is the “gold standard” for determining the patient’s cardiac condition, its stability, and optimization in preparation for surgery. Asking specific questions for the consultant to answer will provide more useful information than “avoid hypoxia, hypercarbia, and hypotension.” ...

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