Читать книгу Ottawa Anesthesia Primer - Patrick Sullivan - Страница 14

Raylene Sauvé MD, Gregory Bryson MD

 Learning Objectives

1 To develop an understanding of the anesthetic considerations for patients undergoing surgical procedures.

2 To perform a preoperative assessment and formulate an anesthetic plan.

  Key Points

1 All preoperative visits should include the following steps: problem identification, perioperative risk assessment, preoperative preparation and proposed plan and technique.

2 It is of paramount importance that anesthesiologists perform a final preanesthetic assessment in the immediate preoperative period to formulate their own “patient-specific” assessment and plan.

3 A patient’s functional capacity is a powerful predictor of postoperative complications.

4 Laboratory and other diagnostic tests should be ordered only when indicated by the patient’s medical co-morbidities or drug therapy or the nature of the proposed surgical procedure.

What is a preoperative assessment, and what is its value to the anesthesiologist?

A preoperative evaluation offers the anesthesiologist an opportunity to define the patient’s medical problems and plan an appropriate anesthetic technique. Additional pre-operative investigations, consultations, and interventions are used to ensure that the patient is in the best possible condition prior to surgery (i.e., preoperative optimization). Following the optimization process, the anesthesiologist can educate and reassure the patient about the procedure, potentially decreasing the patient’s anxiety prior to surgery.

This chapter is intended for care providers who may have little or no exposure to the specialty of anesthesia. It provides the framework to evaluate a patient’s condition, formulate an appropriate anesthetic plan, and communicate this information to colleagues. The preoperative evaluation does not replace the role of the primary care provider and is not meant to address health care issues that are not relevant to the delivery of safe and quality care in the perioperative period.

All preoperative visits should include the following essential steps:

 Problem identification

 Perioperative risk assessment

 Preoperative preparation

 Proposed plan for anesthetic techniqu