Preanesthetic Evaluation Research Articles

Anesthetic Management of a Patient with ARC Syndrome - Arthrogryposis, Renal Dysfunction, and Cholestasis: A Case Report

ARC Syndrome, characterized by arthrogryposis, renal dysfunction, and cholestasis, is a rare genetic disorder often resulting in early mortality due to complications such as bleeding. This report details the anesthetic management of a 14-year-old male with type 1 ARC Syndrome, scheduled for gastrostomy and incisional hernioplasty due to severe malnutrition. The patient was presented with minor but relevant oral bleeding during surgery and, after receiving desmopressin, platelets transfusion and tranexamic acid, was able to be safely extubated. This case underscores the importance of thorough pre-anesthetic evaluation and tailored management strategies to address unique challenges presented by ARC Syndrome, particularly concerning coagulopathy and airway management. While existing literature on anesthetic approaches for ARC patients is limited, strategies such as desmopressin and tranexamic acid may offer benefits in managing bleeding tendencies, warranting further investigation into their effectiveness in this context.

Perioperative dental injury awareness among anesthesiologists

Abstract Background and Aims: Perioperative dental injury is a known yet preventable complication. We assessed the anesthesiologists’ awareness of the predisposing factors, preventive measures, and subsequent management of these injuries, should they occur. Material and Methods: A prospective cross-sectional survey was conducted on 385 anesthesiologists practicing in Delhi-NCR to assess their awareness on prevention and management of perioperative dental injuries. A questionnaire comprising 35 questions designed to determine preanesthetic practices, knowledge of dental injury predisposing factors, preventive measures, injury management, and documentation was filled and the collected data was analyzed. Results: Dental risk assessment was always or mostly performed by 93% anesthesiologists. Most anesthesiologists (93%) felt it would be more informative and clearer if preexisting dental condition is noted on a dental chart. Dental consultation was always advised by 14% anesthesiologists for patients with loose or diseased tooth. Limited mouth opening (71%), intubation (98%), and use of laryngoscope (96%) were found to be associated with dental injury. For dental injury prevention, 74% anesthesiologists padded teeth with gauze and 51% preferred to use a video laryngoscope. Knowledge regarding handling and management of avulsed tooth was lacking in most anesthesiologists. Postanesthesia dental status was documented always by only 11%. However, 71% always documented dental injury. Conclusions: Using dental chart in preanesthetic evaluation sheet improves documentation. Anesthesiologists need to be sensitized to the benefits of preanesthetic dental consultation for vulnerable teeth. They need awareness about correct handling and need of immediate reimplantation of avulsed tooth and documentation of postanesthesia dental status.

Effect of intravenous and intraperitoneal lignocaine on post operative pain scores in dogs undergoing ovariohysterectomy

The study was conducted in twelve female dogs of different breeds, randomly divided into two groups of six dogs each. All dogs underwent a comprehensive pre-anaesthetic evaluation prior to surgery. One hour before the procedure, the dogs received firocoxib orally. Pre-anaesthetic medication included injections of xylazine and buprenorphine, followed by induction with ketamine and midazolam. In Group I, lignocaine was administered during induction followed by a constant rate infusion (CRI), while in Group II, lignocaine was applied directly to the peritoneal cavity and viscera during surgery. Anaesthesia was maintained with isoflurane in both the groups. The quality of sedation, induction and recovery from anaesthesia was noted as excellent in both groups. Haematological and serum biochemical parameters varied within normal acceptable ranges and showed no significant differences between the groups. Electrocardiographic parameters, blood pressure values and blood gas parameters also remained within normal limits, without significant differences between the groups. Pain scores were lower in Group II compared to Group I, although the difference was not statistically significant. Both multimodal anaesthetic protocols proved effective in managing postoperative pain in dogs. Keywords: Pain, multimodal anaesthesia, multimodal analgesia, OHE, GCMPS

The Importance of Pre-Anesthetic Evaluation in Patient Safety: A Systematic Review

Background: Pre-anesthetic evaluation is the initial stage of anesthesia procedures for patients. This evaluation involves elucidating the patient's medical history, determining patient readiness, screening for undisclosed disorders, and identifying risk factors. Safety measures help mitigate patient-related risks within medical environments. The aim of this study is to investigate the role of Pre-anesthetic evaluation in patient safety. Methods: The present study was a review conducted in the year 2024. Databases including PubMed, Direct Science, MEDLINE, Proquest, SID, Scopus, Google Scholar, Magiran, and library resources were searched using keywords such as Pre-anesthetic evaluation, pre-anesthetic visit, anesthesia clinic, patient safety, and their English equivalents. A logical combination of these keywords was performed using "OR," "AND," and "NOT" operators. The search was conducted in relevant articles from the year 2000 to January 2024. Results: Initially, 22,000 articles were screened, and ultimately, 16 relevant articles were used for preparing this paper. In all the reviewed articles, pre-anesthetic evaluation played a key role in patient safety. Conclusions: Studies indicate that pre-anesthetic evaluation is a key improver of surgical outcomes. These measures not only mitigate potential risks but also enhance surgical outcomes. Overall, pre-anesthetic evaluation has a direct correlation with patient safety, playing a significant role in postoperative improvement and elevating the quality of medical care.

Anaesthetic Management in a Patient with Pituitary Macroadenoma: A Case Report

Pituitary tumours are the second most common intracranial tumours. The anaesthetic management of pituitary tumours requires an in-depth understanding of the principles of neuroanaesthesia and pituitary disorders. Immaculate preanaesthetic evaluation, intraoperative management and postoperative care with interdisciplinary teamwork are essential for successful outcomes in surgeries for pituitary tumours. This case report discusses a 34-year-old female patient presenting for the management of a pituitary macroadenoma, illustrating the anaesthetic challenges faced in such cases. The presence of acromegaly, along with co-morbidities such as hypertension, necessitated a detailed anaesthetic management plan. The patient underwent thorough preanaesthetic evaluation and had a transnasal trans-sphenoidal tumour excision under general anaesthesia, following standard protocols for difficult airway management. The patient was intubated using a video laryngoscope and invasive blood pressure and central venous pressure monitoring were conducted. Following surgery, the patient was transferred to the neurosurgery intensive care unit and was subsequently discharged on the 10th postoperative day

Clavipectoral fascial plane block for clavicle fracture surgery: A case report.

Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis. A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period. Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.

A Retrospective Analysis of Non-Operating Room Anesthesia Practices at University Hospital

Abstract: Objective: The use of non-operating room anesthesia (NORA) is increasing due to its advantages in procedure success and patient management. This study aims to retrospectively evaluate the NORA practices at Hatay Mustafa Kemal University hospital over a two-year period. Materials and Methods: After obtaining ethical approval, the records of patients who underwent sedation-analgesia outside the operating room for diagnostic and therapeutic purposes between 2018 and 2020 were retrospectively analyzed. Recorded data included age, gender, weight, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, types of procedures, anesthesia and recovery times, medications used, and complications. Results: A total of 1199 patients were included in the study, with 63.3% (759) adults and 36.7% (440) pediatric patients. The patient group comprised 69.1% (829) female and 30.9% (370) male, with a mean age of 35.62 ± 28.69 years (0-98). Of the patients, 46.1% (547) were in the ASA 2 risk group. The most common procedure was Magnetic Resonance Imaging (MRI) 45.1% (541). The most frequently used anesthetic regimen was a combination of midazolam, propofol, and ketamine 70.1% (840). Hypotension was the most common complication 3.7% (44), followed by bradycardia 3.2% (38). Hypertension was the most frequently (12.0%) observed comorbidity. Conclusion: The frequency of non-operating room anesthesia (NORA) procedures is steadily increasing due to growing patient and surgeon satisfaction. Comprehensive preanesthetic evaluations, ensuring appropriate physical conditions and patient-specific drug selection are crucial for appropriate and rapid interventions for possible complications. Keywords: Non-operating room anesthesia practices, Pre-anesthetic evaluation, Sedation, Anesthetic agents, Complications

Clinical Audit on the practice of Documentation during Preanesthetic evaluation

Pre-anesthesia checkups play a crucial role in ensuring patient safety and positive outcomes during surgical procedures. These assessments are typically conducted before surgery to evaluate the patient's overall health, identify potential risks, and tailor anesthetic plans accordingly. The efficacy of pre-anesthesia checkups can be assessed based on several factors: Risk Identification: Pre-anesthesia evaluations help identify pre-existing medical conditions, allergies, or other factors that could pose a risk during surgery. Recognizing and addressing potential complications beforehand can contribute to better preparation and management during the perioperative period. Optimization of Patient Conditions: Through pre-anesthesia assessments, healthcare providers can work to optimize a patient's medical condition before surgery, such as controlling blood pressure, managing diabetes, or addressing respiratory issues. This optimization can contribute to a smoother anesthesia experience and faster recovery post-surgery. Tailored Anesthetic Plans: Based on the information gathered during the pre-anesthesia checkup, anesthesiologists can develop individualized anesthetic plans that consider the patient's medical history, current health status, and the nature of the surgical procedure. Tailoring the anesthesia approach helps in minimizing complications and adverse reactions. Informed Decision-Making: The pre-anesthesia evaluation allows for informed decision-making by both the patient and the medical team. Patients can be educated about the potential risks and benefits of anesthesia, and their concerns can be addressed before the procedure. Reduced Complication Rates: By addressing potential issues proactively, pre-anesthesia checkups contribute to reducing the occurrence of complications during and after surgery. This, in turn, can lead to improved patient outcomes and a lower likelihood of adverse events. Postoperative Recovery: Adequate pre-anesthetic evaluation and optimization can positively impact the patient's recovery after surgery. Patients who undergo thorough pre-anesthetic assessments are more likely to have a smoother recovery process with fewer complications. Efficient Resource Utilization: Pre-anesthesia checkups help identify patients who may require additional monitoring, specialized equipment, or specific interventions during surgery. This allows for efficient allocation of resources and personnel to address individual patient needs. In conclusion, the efficacy of pre-anesthesia checkups on patient outcomes is well-established. These assessments contribute to safer surgical experiences, reduced complications, and improved overall outcomes by allowing for tailored, informed, and proactive care.

A rare occurrence of enchondroma with pathological fracture of proximal femur in an adult female: A case report

Enchondroma occurrence in the proximal femur is a very uncommon condition. We report a 40-year-old female with a history of accidental slip and fall, sustained injury to her left lower limb, and was unable to bear weight on the injured leg since the fall. Anteroposterior radiograph of the pelvis with bilateral hips shows a well-defined lytic lesion in the neck of the femur with some calcified matrix and no periosteal reaction with the left femoral subtrochanteric fracture. Magnetic resonance imaging scan revealed hypointense signals on T1 and hyperintense signals on T2 sequence over the proximal femur as well as left subtrochanteric femur fracture. After preanesthetic evaluation, bone curettage with excision biopsy with open reduction and internal fixation with long proximal femoral nail and bolts and iliac crest bone graft was done. A biopsy sample sent for histopathological examination reveals enchondroma. Complete weight bearing was started after four months. No recurrence was noted on follow up.

Substance P a potent prognostic indicator for canine mammary tumours- a comparative study

Substance P, a neurotransmitter in the central and peripheral nervous system, is considered as a biomarker of pain due to its key role in nociception. But recent researches have proved the increased expression of Substance P and its receptors in human breast cancers and their role in its progression. Canine mammary glands and spontaneously occurring neoplasms in them are considered best models for human breast cancers. Hence as a preliminary study, the present research work was undertaken to assess the level of Substance P in dogs with mammary tumours in comparison to healthy dogs. From the dogs brought for ovariohysterectomy and mammary tumour resection, 20 female dogs were selected for the study. Signalment and detailed history regarding each dog were recorded. All the dogs were subjected to thorough preanaesthetic evaluation and were grouped into Group I (mammary tumour) and II (control group) with 10 dogs each. Blood was collected from all the dogs and serum was separated and stored at -20ºC for estimation of substance P. The same was performed using sandwich ELISA technique with canine specific Substance P ELISA kit. The values obtained for Group I and II were statistically analysed using independent t- test. The level of substance P was significantly higher in the dogs of Group I when compared to Group II Keywords: Substance P, mammary tumour, dogs

A Retrospective Evaluation of Patients Who Had Den¬tal Treatments Under General Anesthesia

Aim: This retrospective study aimed to evaluate the demographic and operational data of uncooperative healthy individuals and individuals with special needs who underwent dental treatments under sedation and general anesthesia. Methods: Data of 458 patients with special needs and 77 healthy noncooperative patients who were examined at XXX University Faculty of Dentistry between January 2022 and May 2023 and underwent dental treatments under general anesthesia were examined retrospectively. Demographic data of the patients, American Society of Anesthesiologists (ASA) scores, mallampati (MP) scores, disability status, if they have systemic diseases, type of anesthesia (sedation/general anesthesia), anesthetic agents and analgesia used, operation duration and dental treatments, were evaluated. Results: The average age of 535 patients who received dental treatment was 13.5±9.9 years and 58.1% (n=311) of the patients were male and 41.9% (n=224) were female. According to ASA scores, the distribution was 15.7% ASA I, 77.6% ASA II, and 6.7% ASA III. While 14.4% of the patients were systemically healthy, 16.7% had epilepsy, 12.9% had cerebral palsy, 12.1% had mental retardation, and 7.1% had Down syndrome. Of 7.1% had various comorbidities such as cardiological problems. Sedation was applied to 7.3% (n=39) of the patients, and general anesthesia was applied to 92.7% (n=496). The average anesthesia duration was 74.5±34.6 minutes. While the average restorative treatment applied to the patients was calculated as 6.45±3.9, tooth extraction 5.25±4.3, fissure sealant 2.44±2.5, pulp treatment 1.62±0.9; Trauma splint was applied to 3 patients. Conclusions: While pre-anesthesia evaluation is very important in determining the risks in dental general anesthesia and sedation applications, the operating conditions and the general and oral health of the patients are effective in the dental treatment decision.

Comparison of NLP machine learning models with human physicians for ASA Physical Status classification.

The American Society of Anesthesiologist's Physical Status (ASA-PS) classification system assesses comorbidities before sedation and analgesia, but inconsistencies among raters have hindered its objective use. This study aimed to develop natural language processing (NLP) models to classify ASA-PS using pre-anesthesia evaluation summaries, comparing their performance to human physicians. Data from 717,389 surgical cases in a tertiary hospital (October 2004-May 2023) was split into training, tuning, and test datasets. Board-certified anesthesiologists created reference labels for tuning and test datasets. The NLP models, including ClinicalBigBird, BioClinicalBERT, and Generative Pretrained Transformer 4, were validated against anesthesiologists. The ClinicalBigBird model achieved an area under the receiver operating characteristic curve of 0.915. It outperformed board-certified anesthesiologists with a specificity of 0.901 vs. 0.897, precision of 0.732 vs. 0.715, and F1-score of 0.716 vs. 0.713 (all p <0.01). This approach will facilitate automatic and objective ASA-PS classification, thereby streamlining the clinical workflow.

Difficult Airway Prediction in Infants with Apparently Normal Face and Neck Features.

Background/Objectives: Prediction of a difficult airway during pre-anesthetic evaluation is of great importance because it enables an adequate anesthetic approach and airway management. As there is a scarcity of prospective studies evaluating the role of anthropometric measures of the face and neck in predicting difficult airways in infants with an apparently normal airway, we aimed to identify the aforementioned predictors of difficult facemask ventilation and intubation in infants. Methods: A prospective, observational study that included 97 infants requiring general endotracheal anesthesia was conducted. Anthropometric and specific facial measurements were obtained before ventilation and intubation. Results: The incidence of difficult facemask ventilation was 15.5% and 38.1% for difficult intubation. SMD (sternomental distance), TMA (tragus-to-mouth angle distance), NL (neck length) and mouth opening were significantly lower in the difficult facemask ventilation group. HMDn (hyomental distance in neutral head position), HMDe (hyomental distance in neck extension), TMD (thyromental distance), SMD, mandibular development and mouth opening were significantly different in the intubation difficulty group compared to the non-difficult group. HMDn and HMDe showed significantly greater specificities for difficult intubation (83.8% and 76.7%, respectively), while higher sensitivities were observed in TMD, SMD and RHSMD (ratio of height to SMD) (89.2%, 75.7%, and 70.3%, respectively). Regarding difficult facemask ventilation, TMA showed greater sensitivity (86.7%) and SMD showed greater specificity (80%) compared to other anthropometric parameters. In a multivariate model, BMI (body mass index), COPUR (Colorado Pediatric Airway Score), BOV (best oropharyngeal view) and TMA were found to be independent predictors of difficult intubation, while BMI, ASA (The American Society Physical Status Classification System), CL (Cormack-Lehane Score), TMA and SMD predicted difficult facemask ventilation. Conclusions: Preoperative airway assessment is of great importance for ventilation and intubation. Patient's overall condition and facial measurements can be used as predictors of difficult intubation and ventilation.

Perioperative Management of an Unusual Case of Dual Etiology Myopathy Undergoing Surgery for an Adrenal Tumor

Abstract Perioperative care of patients with muscular dystrophy can be challenging. The authors hereby present the successful management of a patient with dual-cause muscular weakness who presented to our institute for adrenalectomy. The patient, a 33-year-old diabetic, hypertensive male, was a diagnosed case of limb–girdle muscular dystrophy. He presented with progressive deterioration of muscular weakness. During workup, he was diagnosed with a cortisol-secreting adrenal mass which contributed to existing myopathy and caused profound muscular weakness. The perioperative course was further complicated by intraoperative massive blood loss and arrhythmias. In patients with dual-cause myopathy, quality of life gets improved after treating the reversible cause. In patients with such complicating features presenting for a major surgery, detailed preanesthesia evaluation, preoperative optimization, and vigilant perioperative care along with multidisciplinary approach helped in successful outcome.

Effects of video-assisted preanesthetic patient education on preanesthetic interview time; A prospective, single-blinded, randomized controlled trial.

A preanesthetic evaluation interview with an anesthesiologist is essential for patient safety, however, it is not performed adequately owing to the excessive workload of doctors. This study aimed to determine whether video-assisted preanesthetic patient education can reduce patient interview time and solve the problem of excessive labor at a relatively low cost. This study considered relatively healthy patients aged 19 to 65 years who were scheduled for elective surgery under general anesthesia. None of the patients had history of general anesthesia. Patients were randomly assigned 1:1 to Groups V and C. Group V watched the preanesthetic education video, while Group C did not. The duration of the preanesthetic evaluation interview was measured for all participants. The satisfaction of the anesthesiologist and patient with the preanesthetic evaluation procedure, anxiety of the patient, and vital signs during surgery were collected. A total of 33 patients in Group V watched the preanesthetic education video, while 31 patients in Group C did not. Group V spent significantly less time on the preanesthetic evaluation interview with an anesthesiologist than that of Group C (172.42 vs 196.68 seconds; P = .005). There was no difference in patient and anesthesiologist satisfaction between the 2 groups (P = .861 and P = .849, respectively). Patients' anxiety (P = .474), intraoperative mean blood pressure (P = .168), and heart rate (P = .934) did not differ between Groups V and C. Watching the informational video about anesthesia before preanesthetic evaluation could reduce the interview time by an average of 24 seconds, with no difference in patients' or doctors' satisfaction or anxiety compared to patients who did not watch it. Video-assisted preanesthetic patient education indicates that the load on anesthesiologists can be reduced.

Enhanced perioperative communication elevates patients' understanding, perception, and satisfaction for anesthesia services: Insights from a survey study.

Anesthesiologists' services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient's knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services. It was a single-center, cross-sectional survey involving 550 patients aged 18-65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients' baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant. Less than half comprehended anesthesia's role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists' services, which might be attributable to the survey-based interaction. A significant need for more understanding regarding anesthesia and anesthesiologists' roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients' knowledge, comprehension, and satisfaction.

Recommendations of the new S1 guidelines on airway management

The German guidelines for airway management aim to optimize the care of patients undergoing anesthesia or intensive care. The preanesthesia evaluation is an important component for detection of anatomical and physiological indications for difficult mask ventilation and intubation. If predictors for a difficult or impossible mask ventilation and/or endotracheal intubation are present the airway should be secured while maintaining spontaneous breathing. In an unexpectedly difficult intubation, attempts to secure the airway should be limited to two with each method used. Avideo laryngoscope is recommended after an unsuccessful direct laryngoscopy. Therefore, avideo laryngoscope should be available at every anesthesiology workspace throughout the hospital. Securing the airway should primarily be performed with avideo laryngoscope in critically ill patients and patients at risk of pulmonary aspiration. Experienced personnel should perform or supervise airway management in the intensive care unit.

Enhancing the Preanesthesia Evaluation: Consensus Development of the Cannabis Use and Behaviors Assessment Tool (CUBAT)

PurposeThis project aimed to develop an evidence-based preanesthesia cannabis use assessment tool to acquire complete and accurate patient history and develop a best-informed, individualized anesthesia and analgesia care plan. DesignModified Delphi. MethodsUsing an evidence synthesis and multistage, modified Delphi process, eight experts from across the United States developed a consensus-based tool to aid in developing a best-informed, individualized plan for anesthesia and analgesia care. FindingsTwo survey rounds integrated informed evidence-based tool revisions. The final tool included instructions for use, a glossary of terms, and seven key assessment items aimed at gathering the most influential information regarding cannabis use. ConclusionsThe Cannabis Use and Behaviors Assessment Tool is a first-of-its-kind tool providing an essential framework for preanesthesia cannabis use assessment.

Incorporation of technology in endodontic treatment of a patient with chronic non-progressive encephalopathy: case report

Objective: This work aims to describe the endodontic treatment performed in a single session in a patient with chronic non-progressive encephalopathy under general anesthesia, using technological devices. Method: A 31-year-old male patient diagnosed with chronic non-progressive encephalopathy, sought dental treatment due to tooth pain. He presented ataxia, atrophy of the upper and lower limbs and involuntary spasms. In the intraoral examination a generalized excessive occlusal wear and temporary restoration on tooth 46 was seen. Periapical radiograph showed increased periodontal space and periapical bone rarefaction. The indication was for endodontic treatment of tooth 46 under general anesthesia. After surgical risk assessment and pre-anesthetic evaluation, endodontic treatment was performed under general anesthesia, using an apical locator, mechanized instrumentation and digital radiography. The tooth restauration was performed in the same clinical moment, without complications. Result: The 8-month follow-up showed absence clinical signs and symptoms and radiographic control without periapical changes. Conclusion: In this case, the incorporation of technology in the endodontic treatment of a patient with chronic non-progressive encephalopathy ensured a safe and effective treatment for the patient and the staff, with case resolution, promotion of oral health and quality of life.

Improvement in Accuracy and Concordance of American Society of Anesthesiologist's Physical Status (ASA-PS) Scoring Assignment over a 11 Year Time Period Using Patient BMI as a Comorbidity Finding.

Anesthesia providers categorize patients utilizing the American Society of Anesthesiologists Physical Status (ASA-PS) classification originally created by the ASA in 1941. There is published variability and discordance among providers when assigning patient ASA scores in part due to the subjectivity of scoring utilizing patient medical conditions, but variability is also found using objective findings like BMI. To date, there are few studies evaluating the accuracy of anesthesia providers' ASA assignment based on objective body mass index (BMI) alone. The aim of this retrospective chart review is to determine improvement in accuracy of anesthesia providers to correctly assign patient ASA scores, based on BMI criteria added to the ASA-PS in October of 2014, utilizing a multifaceted strategy including creation of an active finance committee in the fall of 2015, multiple e-mail communications about the updated definitions and recommendations for ASA-PS scoring in the fall of 2015 and spring of 2016, a department grand rounds presentation in February 2016, placement of laminated copies of the ASA definitions and recommendations in the anesthesia chartrooms, and the development of a tool embedded into our EMR providing a recommendation of ASA-PS based on patient comorbidity findings. After attaining IRB approval, all eligible patients over the age of 18 who had surgical procedures under general anesthesia at Mayo Clinic in Rochester, MN, between January 1, 2010, and December 31, 2020, were retrospectively analyzed. A segmented logistic regression model was used to estimate the trends (per-year change in odds) of ASA under classification according to severity of obesity during 3 epochs: preimplementation (2010-2014), implementation (2015), and postimplementation (2016-2020). A total of 16,467 patients of the 200,423 (8.2%) patients with obesity (class 1, 2, and 3) were underscored based on BMI alone. Accuracy of ASA-PS classification, as it pertains to BMI alone, was found to show meaningful improvement year-to-year following the updated ASA-PS guidelines with examples released in October of 2014 (P < 0.001). Most of the improvement occurred in 2015-2017 with relatively little between-year variability in the rate of underscoring from 2017-2020. Despite updated ASA-PS published guidelines, providers may still be unaware of the updated guidelines and inclusion of examples used within the ASA-PS classification system. Accuracy of scoring did improve annually following the release of the updated guidelines with examples as well as department-wide educational activities on the topic. Additional education and awareness should be offered to those responsible for preanesthesia evaluation and assignment of ASA-PS in patients to improve accuracy as it pertains to BMI.