Preanesthetic Evaluation of the Surgical patient

1. PreanestheticEvaluation of the Surgical patient 마취과 R3 이 재 우

2. I. Preoperative Assessment of surgical patient for anesthesia • issue of appropriate preopeativepreparation • ambiguous and frustrating • surgical procedure performed with anesthesia assistance require some form of preanestheticevaluation • anesthesia is greater risk than surgery itself • preanestheticprocess affect clinical safety and organizational integrity • appropriately prepared patient prevents clinical morbidity

3. II. Cause of simple process to become more complex • surgeon vs. anesthesiologist • selection of procedure • process control • preoperative evaluation uint • no consistent system for risk assessment • multiple professional society

4. III. Preanestheticevaluation • portion of general process of preoperative evaluation • preanestheticactivity • enhance safety, comfort, efficiency of process for patient and clinical staff • focus • safe anesthesia and performance of surgery • acute or chronic medical condition • refer to their primary care provider or organization

5. IV. Risk classification ( 1 ) • Saklad'ssystem • Meyer Saklad, 1941 • first attempt to stratify risk for patient • type of anesthesia and natureof surgery are not consideration • four preanesthesiarisk category ( ASA PS 1-4 )

6. IV. Risk classification ( 2 ) • American Society of Anesthesiologists system • modified Saklad'ssystem • add fifth category • limited application • table - 1

8. IV. Risk classification ( 3 ) • Johns Hopkins Risk Classification System (JHRCS) • evaluate preoperative medical condition and nature of surgery as independent • nature of surgery is major determinant of risk • table – 2

10. V. Patient and Procedure Selection • change in surgical technology, perioperativecare, and postoperative management • preoperative admission • outpatient procedure • Discharge

11. VI. Time of Evaluation • common assumption • utility of preoperative evaluation before the day of surgery is scant and inconclusive • Twersky- evaluate on day of surgery

12. VII. Personnel performing the Evaluation • anesthesiologist • retain all preanestheticinterview responsibility • directly involve with patient's care and ensure appropriate information • assessment of patient with significant medical problem • not performed by anesthesiologist • provided by patient's primary care provider • standard form for review ( table - 3 ) • time of assessment ( table – 4)

16. VIII. Laboratory Testing ( 1 ) • costly issue associated with surgery • cost of care and convenience of patient is major concern • key consideration for relevant to anesthesia • anesthesia is safety condition • prevalence of condition in both symptomatic and asymptomatic patient • test sensitivity and specificity • Cost

17. VIII. Laboratory Testing ( 2 ) • reasonable test • positive finding in history and P/E • need for baseline value in anticipation of significant change due to surgery and medical intervention • patient's inclusion in population at higher risk

19. IX. Communication • appropriate determination of patient medical status and laboratory test • surgeon, all practitioners operate