Could preanesthesia assessment clinics be of benefit in modern anesthetic practice in Nigeria?

Abstract

Preanesthesia assessment is the process of clinical evaluation conducted before anesthetic care. The benefits of outpatient preoperative assessment clinics were discovered and exploited in the developed world for more than 68 years. Surprisingly, these clinics have not been set up and used in Nigeria for the care of surgical patients. A review of operation records in a tertiary healthcare facility over an 18-month period revealed that about 35% of elective surgical cases were cancelled weekly due to reasons ranging from lack of power to lack of sterile gowns, lack of water, and the inadequate preparation of patients among others. Of these, the inadequate preparation of surgical patients accounted for one out of every five elective cases cancelled. These cancellation rates were high. Currently, preanesthesia assessment is routinely performed in the evening of the day preceding planned surgery. This does not allow sufficient time to fully optimize patients with preexisting morbid conditions such as diabetes mellitus, hypertension, thyroid disease, and other chronic illnesses, some of which may require specialist consultation. The pilot study also revealed that relevant investigations ordered by the anesthetists were not usually performed due to the short notice, which resulted in the cancellation of the planned surgery. This article reviewed relevant journals on the structure and benefits of preanesthesia assessment clinics with a view of determining whether the establishment of such clinics could address these shortcomings in surgical care delivery.