TY  - CHAP
M1  - Book, Section
TI  - Overview of Preoperative Assessment and Management
A1  - Gerlach, Rebecca M.
A1  - Sweitzer, Bobbie Jean
A2  - Longnecker, David E.
A2  - Mackey, Sean C.
A2  - Newman, Mark F.
A2  - Sandberg, Warren S.
A2  - Zapol, Warren M.
PY  - 2017
T2  - Anesthesiology, 3e
AB  - KEY  POINTSAnesthesiologists  function  as  perioperative  consultants  when  the  entire  spectrum  of  perioperative  care  is  examined,  not  solely  the  intraoperative  period,  and  interventions  are  implemented  to  improve  overall  outcome.Risk  assessment  tools  are  used  to  quantify  risk  and  provide  a  common  language  for  communication  with  patients  and  colleagues.The  medical  history  and  physical  examination  are  the  cornerstones  of  preanesthetic  assessment.  Preoperative  investigations  are  indicated  to  diagnose  disease  based  on  known  risk  factors  or  to  evaluate  the  current  state  of  an  existing  disease.“Routine”  or  “screening”  preoperative  tests  are  not  indicated,  as  they  are  costly  and  seldom  provide  useful  information.At-risk  patients  are  best  assessed  prior  to  the  day  of  surgery  to  allow  adequate  time  for  assessment  and  implementation  of  indicated  risk  reduction  strategies.  At-risk  patients  may  include  those  withCardiovascular  disease:  hypertension,  ischemic  heart  disease,  coronary  stents,  valvular  disease,  heart  failure,  rhythm  disturbances,  cardiovascular  implantable  electronic  devicesRespiratory  disease:  reactive  airways  disease,  chronic  obstructive  pulmonary  disease,  pulmonary  hypertension,  upper  respiratory  tract  infection,  smokers,  obstructive  sleep  apneaSignificant  systemic  disease:  obesity,  diabetes  mellitus,  renal  disease,  hepatic  disease,  anemia,  neurologic  disease,  cancer,  thromboembolic  disorderSubstance  abuseAnesthesia-specific  concernsAmbulatory  surgeryConsultation  with  other  physicians  should  seek  specific  advice  regarding  the  diagnosis  and  status  of  a  patient’s  condition  or  the  creation  of  a  clinical  risk  profile.  “Preoperative  clearance”  is  seldom  helpful  and  should  not  be  requested.Evidence-based  practice  guidelines  minimize  cancellations  or  delays  on  the  day  of  surgery  resulting  from  individual  practice  variation.  Liberalized  fasting  guidelines  permitting  consumption  of  clear  fluids  until  2-3  hours  preoperatively  are  safe  and  minimize  patient  discomfort.Preanesthetic  assessment  in  clinic  by  an  anesthesiologist  prior  to  surgery  improves  patient  satisfaction  and  alleviates  anxiety;  avoids  medicolegal  culpability  resulting  from  inadequate  assessment  or  unnecessary  testing;  and  is  economically  beneficial  by  minimizing  preoperative  testing  and  avoiding  case  cancellations  or  delays.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1144111319
ER  -