Preprocedural evaluation: considerations outside of the operating room.

Abstract

There are an increasing number of procedures performed in locations outside of the operating room both for children and adults. From the perspective of the anesthesiologist, the preprocedural evaluation is essential in providing safe and high-quality care. This review focuses on the purpose, considerations and methods for providing information during the preprocedural evaluation process based on the most recent literature review. Upon review of the literature, there is an agreement that a preprocedural evaluation is fundamental to the management of our patients. This evaluation is the process of clinical assessment that precedes the delivery of anesthesia for all procedures. Consideration must be given to information from many sources and consultation ordered only as necessary. A determination of the medical condition as indicated by the American Society of Anesthesiologists score must be applied. The evaluation process is relatively standard across institutions. It appears to be more clearly defined among adult patients particularly when presenting with multiple comorbidities, and will tend to be assessed days to weeks prior to the scheduled procedure. Differences may exist, however, among an institutions' overall approach to the preprocedural evaluation of children. Ultimately, the results are efforts by the institutions to improve efficiency, reduce delays and cancellation rates. It is important for the anesthesia provider to perform a thorough preprocedural evaluation. Tests that are ordered as part of the evaluation are done to understand the current medical state, verify a condition or formulate a plan. Informed consent must be obtained and the risks and benefits of the anesthesia plan in a manner understandable to the patient and parent or care giver.Many pediatric patients undergoing procedures outside of the operating room are in good health, and their evaluation will be relatively routine. Other children will present with complex medical conditions that require more time for the evaluation process. This may include the consultation of a pediatric specialist(s) as a necessary step toward completion of the preprocedural evaluation.Similarly, there are adult patients undergoing procedures outside of the operating room, which will have a straightforward preprocedural evaluation and others are more complex. Disease states that might require further testing include diabetes, leukemia, kidney and liver disease, central nervous system disease, malabsorption syndrome, coronary artery disease, coagulopathies and patients on diuretics.