PreanestheticPreanesthetic Evaluation Evaluation of the Surgical patientof the Surgical patient

마취과 R3 이 재 우

I. Preoperative I. Preoperative Assessment of surgical Assessment of surgical patient for anesthesiapatient for anesthesia

issue of appropriate preopeative preparation – ambiguous and frustrating

surgical procedure performed with anesthesia assistance require some form of preanesthetic evaluation– anesthesia is greater risk than surgery itself– preanesthetic process affect clinical safety and org

anizational integrity– appropriately prepared patient prevents clinical mo

rbidity

II. Cause of simple process II. Cause of simple process to become more complexto become more complex

surgeon vs. anesthesiologist selection of procedureprocess controlpreoperative evaluation uintno consistent system for risk assessme

ntmultiple professional society

III. PreanestheticIII. Preanesthetic evaluationevaluation portion of general process of preoperative eval

uation preanesthetic activity

– 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

IV. Risk classification ( 1 )IV. Risk classification ( 1 )

Saklad's system– Meyer Saklad, 1941– first attempt to stratify risk for patient– type of anesthesia and nature of surgery ar

e not consideration– four preanesthesia risk category ( ASA PS 1

-4 )

IV. Risk classification ( 2 )IV. Risk classification ( 2 )

American Society of Anesthesiologists system– modified Saklad's system– add fifth category– limited application– table - 1

IV. Risk classification ( 3 )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

V. Patient and Procedure V. Patient and Procedure SelectionSelection

change in surgical technology, perioperative care, and postoperative management

preoperative admissionoutpatient procedureDischarge

VI. Time of EvaluationVI. Time of Evaluation

common assumptionutility of preoperative evaluation before t

he day of surgery is scant and inconclusive

Twersky - evaluate on day of surgery

VII. Personnel performing VII. Personnel performing the Evaluationthe Evaluation

anesthesiologist– retain all preanesthetic interview responsibility– directly involve with patient's care and ensure appr

opriate 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)

VIII. Laboratory Testing ( 1 VIII. Laboratory Testing ( 1 ))

costly issue associated with surgery cost of care and convenience of patient is maj

or concern key consideration for relevant to anesthesia

– anesthesia is safety condition– prevalence of condition in both symptomatic and a

symptomatic patient– test sensitivity and specificity– Cost

VIII. Laboratory Testing ( 2 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

IX. CommunicationIX. Communication

appropriate determination of patient medical status and laboratory te

st– surgeon, all practitioners operate