Preoperative Anesthesia Clinic

Abstract

WHAT IS A PREOPERATIVE ANESTHESIA CLINIC? preoperative means: before surgery anesthesia means: methods to put you asleep and/or make you pain-free for surgery anesthesia clinic means: a space within the hospital in which you can talk to an anesthesiologist and a nurse in the days before your surgery A preoperative anesthesia clinic Figure 1 Image 1: A preoperative anesthesia clinic Figure 2 WHY IS IT GOOD TO HAVE A PREOPERATIVE ANESTHESIA CLINIC? The goal of the preoperative anesthesia clinic is to clear the patient medically for anesthesia prior to having either surgery or another painful procedure. All patients must be cleared for anesthesia even if they are scheduled for sedation (combination of medications causing drowsiness) as complications during the procedure may require the patient to receive general anesthesia (patient being completely asleep). The objective is to determine whether the patient is optimized (best prepared) for surgery. That is, is the patient's health as good as it can be considering their medical history and prescribed medications. DO ALL HOSPITALS HAVE A PREOPERATIVE ANESTHESIA CLINIC? No, not all hospitals have such a clinic. In order to operate such a clinic a hospital must have enough space, personnel and money. It is not cheap to run a preoperative HOW DOES A TYPICAL VISIT LOOK? The appointment may consist of the following five parts: Preoperative Anesthesia Clinic 2 of 7 A Questionnaire filled out by the patient 1. Nurse's Interview 2. Anesthesiologist's Interview and Physical Exam 3. Tests: Laboratory (blood), Chest X ray, 4. Electrocardiogram (EKG); Possibly: Pulmonary Function Tests (lung), Cardiac stress test (heart), or other heart tests Summary Interview: Questions answered by doctor 5. and instructions given by nurse for admission WHAT KIND OF PAPERWORK WILL YOU HAVE TO FILL OUT? Patients will usually be asked to fill out a questionnaire describing their past medical history, current complaints, current medications, and other important information. A variety of questions are asked to gather information about the major organ systems, i.e. do you have chest pain, do you have difficulties do breathe, do you have known allergies, and so on. In addition, some questions about your social background are asked. And finally, some information about your insurance is collected. WHAT WILL YOU BE ASKED BY THE NURSE DURING YOUR VISIT? Two systems that Anesthesiologists focus on are the heart (cardiac) and the lung (respiratory) systems. If the patient has other existing diseases, these too are evaluated. Occasionally, an additional test may be used to evaluate current, new problems that may have arisen. After the paperwork is completed, the nurse will assess the patient's vital signs (blood pressure, heart rate, and temperature). If available from other hospital or doctor visits, it is extremely helpful for the patient to have a file containing their latest blood results, chest X ray report, electrocardiogram report, and other more specialized reports such as cardiac stress test, heart electrocardiogram and/or echocardiogram, CT scan reports, or pathology reports. We usually gather these documents by fax from the respective doctors' offices during your visit but this may cause a significant delay in the time spent in the preoperative anesthesia clinic. Figure 3 Image 2: A nurse interview WHAT WILL YOU BE ASKED BY THE DOCTOR (ANESTHESIOLOGIST) DURING YOUR VISIT? The anesthesiologist will start by reviewing the available information in the medical chart of the patient. The anesthesiologist will typically fill out a preoperative evaluation sheet that will be used to prepare the best plan for anesthesia. Medications are discussed in detail. Having a pre prepared list of doses of medications can be extremely helpful for the medical staff. Which medications to be taken prior to the procedure will be outlined during the visit. Patients are instructed to not eat or drink anything after midnight the night prior to the surgery or procedure. Eating or drinking will result in cancellation of the planned procedure that day. If the patients have food in their stomach they may inadvertently vomit it into the lungs during their anesthesia which can result in a chemical pneumonia (aspiration pneumonia). This could result in being put on the lung machine (ventilator) in the intensive care unit (ICU) and might lead to deadly complications. Preoperative Anesthesia Clinic 3 of 7 Figure 4 Images 3 and 4: The “Anesthesiologist” flag indicates that the patient is ready to be seen by an anesthesiologist; An anesthesiologist interview