TY  - CHAP
M1  - Book, Section
TI  - Chapter 6. Overview of Preoperative Assessment and Management
A1  - Sweitzer, Bobbie Jean
A1  - Pilla, Michael
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - Comprehensive  preoperative  evaluation  and  management  improve  patient  satisfaction,  outcomes,  and  safety.Inadequate  preoperative  evaluation  and  management  increase  perioperative  adverse  events  and  often  lead  to  delays  or  cancellations  of  procedures.At  a  minimum,  the  preanesthesia  visit  should  include  an  interview  with  the  patient  to  review  the  medical  history  (including  medications,  allergies,  comorbid  conditions,  previous  operations,  and  anesthetics),  an  appropriate  physical  examination,  review  of  diagnostic  data,  assignment  of  an  American  Society  of  Anesthesiologists  physical  status  score,  and  a  formulation  and  discussion  with  the  patient  of  the  anesthetic  plan.The  medical  history  is  the  most  important  component  of  preoperative  assessment.Findings  from  the  history  and  physical  examination  determine  the  need,  if  any,  for  further  diagnostic  testing.Diagnostic  tests  should  only  be  ordered  if  the  results  will  alter  the  planned  anesthetic  or  procedure  or  establish  an  already  suspected  diagnosis.  "Screening"  tests  are  never  appropriate.Cardiovascular  morbidity  and  mortality  are  the  leading  cause  of  significant  perioperative  adverse  events.Identification  and  management  of  cardiovascular  disease  is  an  important  goal  of  preoperative  evaluation.Knowledge  of  risk  factors  for  cardiovascular  disease  and  familiarity  with  the  American  College  of  Cardiology–American  Heart  Association  guidelines  for  cardiovascular  evaluation  for  noncardiac  surgery  is  essential.A  determination  of  functional  capacity  or  the  patient's  cardiorespiratory  fitness  can  guide  further  testing  and  predict  a  wide  range  of  complications  and  outcome.Potentially  high-risk  patients  include  those  with  the  following  conditions:  Ischemic  heart  diseaseHeart  failureMurmursPacemakers,  implantable  cardioverter-defibrillators  (ICDs)Vascular  stentsPulmonary  diseaseObstructive  sleep  apneaObesityDiabetes  mellitusPoorly  controlled  hypertensionRenal  diseaseHepatic  diseaseSubstance  abuseAdvanced  ageDifficult  airwayKnowledge  and  management  of  antiplatelet  therapy  in  patients  with  coronary  stents  is  imperative  in  the  perioperative  period.Poor  communication  is  a  common  source  of  medical  errors,  patient  dissatisfaction,  and  malpractice  claims.Practice  guidelines  can  standardize  care,  decrease  delays,  and  improve  outcomes.Anesthesia-directed  preoperative  evaluation  centers  can  be  cost-effective,  improve  care  and  safety,  and  offer  services  beyond  history  acquisition,  physical  examinations,  and  diagnostic  testing.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56621180
ER  -