Preoperative Evaluation and Preparation for Anesthesia and Surgery - An Overview

Introduction

An intricate stress response is linked to surgical operations and the administration of anesthesia, and it is correlated with the severity of the damage, the duration of the operation, the amount of blood lost during the process, and the level of postoperative discomfort. During the perioperative phase, several issues may arise due to the negative impact of this stress response on metabolism and hemodynamics. Improving outcomes, reducing the duration of hospital stay, and lowering the overall costs of patient care all depend on reducing the stress response to surgery and trauma.

It is widely understood that optimal patient care is necessary for safe and effective surgical and anesthetic practices. Several extensive epidemiological studies have suggested that one of the main reasons for perioperative mortality may be the patient's poor preoperative preparation.

What Are the Objectives of Preoperative Evaluation and Preparation for Anesthesia and Surgery?

The preoperative examination and preparation have been shown to have the following main objectives:

• Documentation of the conditions that require surgery.

• Evaluation of the patient's general state of health.

• Identifying latent conditions that may give rise to complications during and after surgery.

• Perioperative risk assessment.

• Improvement of the patient's health to lower the risk of perioperative morbidity or mortality from surgery and anesthesia.

• Development of a suitable strategy for perioperative care.

• To reduce fear and speed up recovery, the patient receives information about surgery, anesthesia, intraoperative care, and postoperative pain management.

• Reduced costs, shorter hospital stays, fewer cancellations, and more patient satisfaction.

How to Record the Patient History for Anesthesia and Surgery?

• The preoperative evaluation's most crucial element is the patient's history.

• A patient's past and present medical history, surgical history, family history, social history (tobacco, alcohol, and illicit drug use), allergy history, current and recent drug therapy, unusual drug reactions or responses, and any issues or complications related to prior anesthetics should all be included in the history.

• It is also important to find out whether there is a family history of anesthesia-related side effects.

• In the case of children, the history should also include the birth history, with particular attention to risk factors, including preterm delivery, problems during pregnancy, congenital chromosomal or anatomical anomalies, and a history of recent infections, particularly respiratory tract infections (upper and lower).

• A thorough examination of the systems should be part of the history to look for chronic diseases that are either poorly managed or go undetected.

• The most important conditions for surgical and anesthetic readiness are those affecting the heart and lungs.

How to Perform Physical Examination Before Anesthesia and Surgery?

The physical examination should be conducted based on the information obtained during history. A targeted preanesthesia physical examination should, at the very least, evaluate the patient's heart, lungs, and airway while recording their vital signs. Before elective surgery, any unexpected aberrant results on the physical examination should be investigated.

What Are the Routine Laboratory Tests That Are to Be Done Before Anesthesia and Surgery?

It is well acknowledged that the most effective way to check for the presence of disease is through a clinical history and physical examination. It is neither cost-effective nor useful to do routine laboratory testing on individuals who appear healthy based on their history and clinical examination. Any prescribed lab test should have its risk-benefit ratio considered into account by a practitioner. Results that are not within the normal range will be found only in five percent of patients in a healthy population. The information gathered from the patient's history and physical examination, their age, and the challenges of the surgical treatment should all be taken into consideration when ordering lab tests.

1. The Complete Blood Count:

• Extensive surgery

• Chronic illness of the heart, lungs, kidneys, or liver; or cancer, and known or suspected anemia

• A child less than a year old

2. Activated Partial Thromboplastin Time (aPTT) and International Normalized Ratio (INR):

• Anticoagulant medication

• Bleeding disorders

• Liver disease

3. Electrolytes and Creatinine

• High blood pressure

• Kidney disease

• Diabetes mellitus

• Adrenal disease

• Diuretic or Digoxin treatment, as well as other medication therapies impacting electrolytes

4. Fasting Glucose

• Diabetes (this test needs to be done again the day before the operation)

• An electrocardiogram (ECG)

• Hypertension and heart disease

• Additional heart disease risk factors, which may include age, headache, cerebrovascular accident, and subarachnoid or intracranial hemorrhage

5. Radiograph of the Chest

• Heart or lung conditions

• Malignancy

What Is the Importance of Recording Drug History Before Anesthesia and Surgery?

• It is important to collect a medication usage record from every patient.

• In particular, more people in their senior years than any other age group use systemic drugs. This demographic has a high rate of medication interactions and problems, thus extra care should be given to them.

• Although some dosage adjustments (e.g., insulin and antihypertensives) may be necessary, most medication administration should be continued up until and including the morning of the surgery.

• Before surgery, a few drugs should be stopped. Due to the possibility of interactions with anesthesia-related medications, Monoamine Oxidase Inhibitors should be stopped two to three weeks before surgery. Due to the elevated risk of venous thrombosis, the oral contraceptive pill should be stopped at least six weeks before elective surgery.

• The American Society of Anesthesiologists (ASA) has conducted a study on the usage of herbal supplements and the possible risks associated with prolonged use of these products before surgery. It is asked of every patient to stop using herbal supplements no less than two weeks before surgery.

• The use of drugs that increase bleeding must be carefully considered; a risk-benefit analysis for each medicine should be conducted, and a suggested time frame for stopping should be established based on the drug's half-life and clearance characteristics.

• To prevent severe bleeding, stop taking Aspirin seven to ten days before surgery. Patients should also stop taking Thienopyridines, such as Clopidogrel, two weeks beforehand. It is possible to continue using selective Cyclooxygenase-II (COX-II) inhibitors until surgery since they do not exacerbate bleeding. Four to five days before invasive operations, oral anticoagulants should be stopped to allow for INR to a normal level before surgery.

Conclusion

To ensure patient safety and maximize results, preoperative examination and preparation for anesthesia and surgery are essential parts of patient care. Healthcare practitioners can reduce problems and improve patient preparation for operations by conducting thorough assessments, identifying risk factors, and implementing customized treatments. Successful interdisciplinary teamwork and communication are further factors in this process's success. Healthcare providers can reduce the risk of unfavorable outcomes and enhance surgical experiences by attending to the specific requirements of each patient and following established guidelines.