Preoperative Anesthesia Research Articles

Our Anaesthetic Experiences in Patients Undergoing Percutaneous Mitraclip Implantation.

Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68.5±10.2 years) were retrospectively investigated in terms of anaesthetic management. Of the 84 patients undergoing percutaneous mitraclip implantation under general anaesthesia, 84.5% had sodium thiopental and 75% had midazolam for anaesthesia induction. For the maintenance of anaesthesia, 57% of the patients were reported to have sevoflurane, whereas the rest had desflurane. The mean duration of the procedure and anaesthesia was 140.9±48.2 mins and 165.7±50.6 min, respectively. Seventy seven patients were transported to the intensive care unit and intubated after the procedure. The median extubation time was 3 h. Length of stay in the intensive care unit was 2 days, whereas it was 4 days for hospital stay. One patient died during the procedure and six patients died after the procedure. Percutaneous mitraclip implantation procedure is quite difficult for anaesthesiologists because of the procedure itself and the population on which the procedure is performed. The primary aim of anaesthesia management is to provide haemodynamic stability. The preoperative preparation and anaesthesia methods should be the same as for patients undergoing cardiac surgery. It is reported that as the experience regarding this subject increases, success of the procedure increases, with better protected haemodynamic stability, less inotropic and vasopressor requirement and shorter length of hospital stay.

Estimating the number of difficult airway carts needed in an operating suite: Resource planning without compromising patient safety

Study ObjectiveTo determine the number of difficult airway (DA) carts required based on the number of anesthetising locations and patients risk of DA. DesignBinomial distributions. Setting and PatientsVarious hypothetical settings and patient cohorts. Interventions and MeasurementsBinomial distributions were used to calculate the number of distinct combinations of DAs by number of anesthetising locations assuming an average risk of 10%. The ‘at least’ number of DAs was calculated using cumulative probabilities of having exactly two plus more than 2 DAs up to the total number of simultaneously started anesthetising locations or until the cumulative probability exceeds the 50% threshold, therefore being more likely than not. Main ResultsThe probability of encountering concurrent DAs increases as the number of simultaneously started anesthetising locations increases. For at least 2 concurrent DAs, the probability first exceeds 50% at 17 locations. The corresponding thresholds for at least 3 and 4 concurrent DAs, are 27 and 37 locations respectively. The probability of at least 2 concurrent DAs will exceed 50% when approximately 17 anesthetising sites are started simultaneously and a 10% worst case risk is assumed. ConclusionsWith continuing resource constraints, proper planning of human and capital resources for DAs needs to be addressed without compromising patient safety. It is recommended that every block of 15–20 sites be equipped with a DA cart, that anaesthesia groups develop and rehearse DA algorithms with available equipment, and that preoperative anaesthesia clinics be used to identify DA therefore providing logistical leverage.

Preoperative Preparation and Anesthesia for Trabeculectomy.

ABSTRACTPreoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted.Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation.How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35.

A Model for Better Leveraging the Point of Preoperative Assessment: Patients and Providers Look Beyond Operative Indications When Making Decisions.

Previous literature on preoperative evaluation focuses on the impact on the day of surgery cancellations and delays; however, the framework of cancellations and delays at the time of the elective outpatient preoperative anesthesia visit has not been categorized. We describe the current model in the preoperative clinic at Brigham and Women's Hospital, examining the pattern of cancellations at the time of this preoperative visit and the framework used for categorizing the issues involved. Looking at this broader framework is important in an era of patient-centered care; we seek to identify targets to modify the preoperative assessment and adequately assess and capture the spectrum of issues involved. Elective cases evaluated in the preoperative clinic were reviewed over 10 months. Characteristics of cancelled and noncancelled cases were compared. In-depth analysis of issues related to cancellation was done; 1-year follow-up was completed. Cancellation patterns included categories encompassing clinical, financial, alignment with patient values and goals, compliance, and social issues. The period of preoperative assessment can therefore be leveraged to review a number of domains that can adversely affect surgical outcomes and improve patient-centered care. Also, our framework allows the institution to benchmark these patterns over time; increases in cancellations at the time of the preoperative anesthesia clinic visit for specific categories can prompt an opportunity to examine and improve preoperative workflow.

Existential questions prior to elective surgery. Survey in a preoperative anesthesia consultation service

Existential questions concerning the limitation of treatment must be answered when a major complication occurs after an elective operation. In these situations, the patient himself/herself cannot be asked about his/her will. Therefore, medical professionals must attempt to determine the patient's presumed will either through an existing advance directive (AD) or by consulting with the patient's relatives. Only one-fifth of all patients create an AD in advance, and the relatives cannot always reliably reproduce the patient's presumed will. Thus, it is important to talk about issues such as do-not-resuscitate before a patient undergoes elective major surgery. However, such discussions may unsettle and frighten the patient. This study aimed to determine if patients are willing to talk about difficult questions such as resuscitation before major surgery. How many patients create an AD? Who should decide when patients themselves are no longer capable? Between March 1 and October 30, 2014, patients who attended the preoperative anaesthesia consultation service received a one-page questionnaire. In addition to a few personal questions (e.g. sex, age, surgery, health status), the questionnaire included four questions that could be answered according to a four-point Likert scale, with a yes or no response, or a with a selection of answers. 272 men (45.5%) and 321 women (53.7%) with a mean age of 52.9 years (standard deviation: 17.8 years) completed a questionnaire. 312 patients (52.2%) claimed to be healthy, while 116 patients (19.4%) observed a minimal health restriction. 125 patients (19.4%) suffered from a chronic illness that markedly (n = 108) or strongly (n = 17) limited daily life. More than three-fourths of the respondents were very ready (377/63.0%) or ready (79 patients/13.2%) to talk about the treatment of severe complications after an elective operation. 12.7% of the patients would rather not to talk about this topic (n = 47) or refused (n = 37). 58 patients (9.7%) checked the box "I do not know" or gave no answer. There was no significant difference between men and women (p = 0.58). The patient's state of health did not significantly affect the patient's willingness to talk (p = 0.61). 110 patients (18.4%) had already completed an AD. The probability of having an AD is highly dependent on the age and state of health. The likelihood of having one increases by 4% for each year of life, and in health-impaired patients it is 73% higher than in healthy ones. If the patient could no longer decide for himself/herself, the following options were selected from multiple possible answers: a relative decides (n = 272), discussing this with a physician prior to surgery (n = 212), previously created AD (n = 198), the treatment team decides (n = 28), I do not know/not (n = 48). Although the majority of the respondents were willing to talk about difficult issues before an operation, it remains unclear to what extent these results can be generalized. However, the results justify efforts to carefully inquire about and document the will of sick patients prior to major surgery. Both the treatment team and the relatives are relieved if the patient's will is known when difficult decisions have to be made.

Removal of foreign bodies from the respiratory tract of young children: Treatment outcomes using newly developed foreign-body grasping forceps

BackgroundAlthough a foreign body in the airway of children constitutes a medical emergency, most available therapeutic tools are insufficient, and treatment can be difficult. Herein, we evaluated the outcomes of various treatment methods of foreign body removal from the respiratory tract. MethodsWe retrospectively analyzed 24 children (13 boys, 11 girls; median age, 18months [range, 9–60months]) treated for airway foreign bodies from January 1994 to December 2013 by examining their preoperative diagnoses and anesthesia and surgical methods. ResultsThe foreign body was a peanut, green soybean, almond, chestnut, dental prosthesis, and bead in 15, 3, 3, 1, 1, and 1 cases, respectively. General anesthesia was used in all cases, and flexible bronchoscopy was performed under airway maintenance using a laryngeal mask in 23 cases. The mean operation time was 51±32min. Grasping forceps, basket forceps, and a Fogarty catheter were used in 14, 7, and 2 cases, respectively. In July 2003, 3-pronged foreign-body grasping forceps with a 2.0-mm diameter designed for use with a thin bronchoscope were introduced. Of 16 treated cases, 9 were successfully treated with only forceps. The mean operation time was significantly shortened to 38±24min (range, 7–91min) compared to the traditional operation time of 82±42min (range, 23–147min) (p=0.01). ConclusionsThese novel forceps are useful for reducing the operation time and are suitable for removing airway foreign bodies from children with a narrow tracheobronchial caliber.

What Patients Really Want: Optimizing the Military Preoperative Evaluation Clinic.

The idea of the preoperative anesthesia clinic as a means of examining and treating the patient so that he will arrive in the operating theater as strong and healthy as possible is well established in practice and literature.However, problems in clinic design and execution often result in high patient waiting times, decreased patient and staff satisfaction, decreased patient capacity, and high clinic costs. Although the details of clinic design, outcomes, and satisfaction have been extensively evaluated at civilian hospitals, we have not found corresponding literature addressing these issues specifically within military preoperative evaluation clinics. We find that changing to an appointment-based (versus walk-in) system and eliminating data collection step redundancies will likely result in lower wait times, higher satisfaction, lower per patient costs, and a more streamlined and resource-efficient structure.

The effect of an anaesthetic patient information video on perioperative anxiety: A randomised study.

Despite growing evidence that an educational anaesthesia video can effectively reduce perioperative anxiety, the ideal medium for addressing perioperative anxiety is unclear. The purpose of this study was to investigate the effect of viewing an anaesthetic patient information video on anxiety levels in patients scheduled to undergo surgery. A randomised controlled trial. Pingtung Christian Hospital (PTCH), Taiwan. One hundred patients were randomised to either an experimental group (n = 50) or a control group (n = 50). At the preoperative clinic, the experimental group watched the an 8 minute educational anaesthetic video, whereas the control group received a standard 8-min verbal briefing on anaesthesia after preoperative assessment. The Chinese version of the Spielberger state trait anxiety inventory, which included a state scale (STAI-S) and a trait scale (STAI-T), was performed in the preoperative clinic (T1) before anaesthetic preassessment, at the preoperative holding area just before surgery (T2) and again on the third day after surgery (T3). Scores for overall satisfaction with medical care were obtained on the third day after surgery. For two time interval comparisons, effect size was used to standardise the extent of change as measured by STAI-S. After the educational intervention, state anxiety was lower in the experimental group than in the control group at both T2 (42.9 ± 6.5 vs. 45.0 ± 12.7) and T3 (40.2 ± 5.3 vs. 48.8 ± 8.5). Compared with control group, the experimental group had a larger effect size at T2 and T3 (-0.65 and -0.36, respectively). Overall satisfaction was significantly higher in the experimental group than in the control group (P < 0.05). Perioperative anxiety was significantly reduced and overall patient satisfaction increased after viewing a preoperative educational anaesthesia video compared with a standard verbal briefing on anaesthesia.

Dedicated teams to improve operative room efficiency

PurposeThe goal of this study was to determine if a dedicated operative room (OR) team would improve OR efficiency. MethodsA pilot program was initiated at an endocrine surgery service at a tertiary medical center to improve operative room efficiency as part of a comprehensive unit-based safety protocol (CUSP). The service already underwent standardization of pre-operative workup, OR equipment, operative technique, and anesthesia protocol. As a pilot, one surgeon had a dedicated OR team consisting of regular scrub and circulating nurse oriented specifically for endocrine surgeries. The pre - and post- CUSP times were compared to the other surgeons on the service. OR time, turnover time, and first start times were measured. ResultsA total of 25 cases were performed with the new nursing team as compared to the 85 done historically. The overall OR time was decreased form 125.51 minutes to 112.1 minute (p 0.05), whereas the control group did not have any statistical difference during this time, 172.2 minutes compared to 171.3 minutes (p=0.9). Turnover with the team was improved by 9.0% at 26.4 minutes from 29.0 minutes and first start OR times improved to 7:20 AM from 7:22 AM, however neither of these changes reached statistical significance (p>0.05). ConclusionThis pilot program indicates that a dedicated team in the operative room can reduce operative time. We attributed this to reduction in delays and distractions as well as increased experience with the flow of the operation. We feel this improves patient safety while reducing operative costs.

Are pedicle screw constructs really more expensive than hybrid constructs?

Background: The purpose of this study was to determine the total expenses of all pedicle screws compared with hybrid constructs in adolescent idiopathic scoliosis (AIS), when cost of revision posterior spinal fusion (PSF) surgery is included. Methods: A retrospective review of 872 consecutive patients with AIS that underwent PSF at a single institution from 1996 to 2009 was performed. Inclusion criteria were AIS, PSF with instrumentation, and a minimum 2-year follow-up. Patient demographics, radiographic parameters, operative data, and comprehensive hospital charges were recorded. Results: One hundred and sixty-seven patients with a mean age of 14 (range 10-26) years and 11 levels (range 5-15) fused met inclusion criteria. There were no significant differences in mean preoperative Cobb angle (P=0.09), operative duration (P=0.48), or anesthesia time (P=0.82). There were no implant-related surgical revisions among the 44 patients with all pedicle screws compared to 29 revision surgeries in 21/123 (17%) patients in the hybrid group (P=0.003). Present day charges at our institution for an 11-level fusion using titanium implants are $42,450 for the average pedicle screw construct and $26,064 for the average hybrid construct. However, when revision charges were added, mean charges for the pedicle screw group at final follow-up were slightly higher than the hybrid group ($42,450 compared to $39,397). Conclusions: Patients with AIS undergoing PSF with all pedicle screw constructs had a markedly lower revision rate than hybrid constructs (0% compared to 17%), but total charges were 7.2% higher. Although the monetary cost of pedicle screw constructs are slightly higher, we believe the markedly lower revision rate justifies their use.

An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia.

Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation.Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah’s Dental Anxiety Scale (DAS). After checking the vital signs the initial pulpal oxygen saturation (initial SpO2) was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2) was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2) was measured.Results. The mean initial (SpO2) was 96.37% which significantly decreased to 90.76% (SpO2) after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2) after administration of local anesthetic solution. Statistical significance was set at P<0.0001.Conclusion. High concentrations of irritants may permeate dentin due to a considerable decrease in the pulpal blood flow from crown or cavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury.

Anesthetic management of reconstructive surgery on the respiratory tract

In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.

Preoperative anxiety-an important but neglected issue: A narrative review

Anxiety is an emotional state characterized by apprehension and fear resulting from the anticipation of a threatening event. The incidence of preoperative anxiety ranges from 11% to 80% in adult patients and also varies among different surgical groups. Preoperative anxiety may lead to various problems and a wide range of physiological and psychological responses. A variety of objective and subjective methods are available for measuring preoperative anxiety. Every patient scheduled for surgery should be assessed for the presence of anxiety in their routine preoperative anesthesia assessment, and counseling should be done by anesthesiologist in patients with a high level of anxiety. Surgery information reduces anxiety in the preoperative period.

DrawMD APP-aided preoperative anesthesia education reduce parents anxiety and improve satisfaction

ObjectiveThere is no existing standard format for preoperative anesthesia education. The drawMD APP is an visible preoperative education tool. The aim of this study was to evaluate the effects of drawMD APP on pre-operative anesthesia education. MethodsThe parents were randomized to receive drawMD APP-aided pre-operative anesthesia education or standard verbal education. Parental anxiety was measured before education (T0) and immediately after education (T1), and after operation (T4). Children’s anxiety was assessed before education (T0) and at the operation room (T2). Children’s emergence behavior and Parents’ satisfaction were assessed after operation (T4). ResultsThe parents’ anxiety levels at T1 and T4 were significantly lower than that of the control. The satisfaction scores in the drawMD group were significantly higher than that in the control group. There were no differences in children’s anxiety and the incidence of emergence delirium between the two groups. ConclusionsThe drawMD APP-aided pre-operative education is effective in the reduction of parental pre-operative anxiety and in improvement of parents’ satisfaction, but has no influence on children. Practice implicationsAnesthesiologists can consider using drawMD APP to conduct pre-operative education in parents whose children are scheduled for surgery.

Association Between Anxiety Level of Child with Parental and Patient Factors During Preoperative Anesthesia Visit

Association Between Anxiety Level of Child with Parental and Patient Factors During Preoperative Anesthesia Visit

Optimizing of preoperative preparation and anesthesia care in newborns with necrotizing enterocolitis

The article presents the results of a study of 128 patients to assess the clinical course of preoperative preparation, anesthetic technique, the study of central hemodynamics, mathematical analysis of heart rhythm in newborns operated on necrotizing enterocolitis (NEC). Depending on the method of anesthesia, patients were divided into 4 groups. Studies were carried out on 5-stages of anesthesia: after premedication, induction of anesthesia, the beginning of the operation, the time of surgery and traumatic awakening. Assessment of hemodynamic parameters was provided: heart rate, blood pressure. Study on the application of reosorbilackt showed that the use of this drug in the hypovolemic state in newborn helped to improve as a central hemodynamics and microcirculation. Multi-agent anesthesia with an inhalation anesthetic sevoflurane is characterized by fast and easy induction, leads to decrease the need in muscle relaxants by 20%. The use of multi-agent anesthesia with GHB in combination with fentanyl is the best method for emergency surgical interventions with hypodynamic type of circulation.

Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p&lt;0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

Preoperative smoking cessation counseling activities of anesthesiologists: a cross-sectional study.

BackgroundSmokers undergoing surgery are at a higher risk of complications than non-smokers. Preoperative evaluation by an anesthesiologist could provide an excellent opportunity to promote smoking cessation. Previous surveys of anesthesiologists have found that self-reported smoking cessation counseling rates have room for improvement, but no study has surveyed patients to obtain more accurate estimates.MethodsA single-center study was conducted from January 2010 to June 2010 in a tertiary teaching hospital. A telephone survey was conducted, which included all adult cigarette smokers who visited the preoperative anesthesia clinic. The survey recorded anesthesiologist-delivered interventions to help patients quit smoking before surgery. At the end of the study period, the self-reported smoking cessation counseling of the anesthesiologist was evaluated by questionnaire.ResultsOne thousand one hundred and sixty-five patients were evaluated, of which 217 were current smokers with a median pack-year of 15 (interquartile range 5.25–30.00) and 34% were scheduled to undergo major surgery. With regard to preoperative interventions, most anesthesiologists (85%) asked about smoking status, although only 31% advised patients about the health risks of smoking and 23% advised patients to quit before surgery. Provision of assistance to help patients quit was provided in 3% of cases. By contrast, 75% of anesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking.ConclusionsThis study shows significant discrepancies between direct patient surveys of preoperative smoking cessation counseling activities by anesthesiologists and the self-reported perceptions of the anesthesiologists. Future studies are urgently needed to evaluate the provision of educational materials and other interventions to improve smoking cessation counseling rates among anesthesiologists and to narrow these discrepancies.

Évaluation du recours à l’anesthésiste-réanimateur lors de la chirurgie de la cataracte réalisée sous anesthésie topique

The current demographic situation in France regarding anesthesiologists calls for a reconsideration of anesthesia management for patients undergoing cataract surgery under topical anesthesia. This prospective observational study aimed to assess the requirement for anesthesiologist intervention during cataract surgery performed under topical anesthesia. Patients operated between November 2, 2011 and July 31, 2012 were included after indication of topical anesthesia for phacoemulsification proposed by the surgeon and confirmed by the anesthesiologist. Each patient was premedicated. All patients were monitored and supervised during the surgery by a nurse anesthesiologist. An anesthesiologist could be called at any time at the request of the surgeon or nurse anesthesiologist. For each patient, medical histories were recorded as well as the event "anesthesiologist called", along with the reason and the treatment performed. Five hundred and seventy-five phacoemulsifications were performed in 486 patients. The event "anesthesiologist called" was recorded 20 times: 18 times for hypertension, once for anxiety and once for non-emergent conversion to general anesthesia after a surgical complication. Each episode of hypertension was successfully treated by following the nicardipine protocol. Preoperatively uncontrolled hypertension was the only significant predictive risk factor for anesthesiologist requirement. These results question the usefulness of preoperative anesthesia consultation for all patients who underwent phacoemulsification under topical anesthesia, since this consultation does not lead to an anesthesiologist service. Intraoperative medical complications may be treated according to medical protocols developed jointly by surgeons and anesthesiologists. This practice may free up anesthesiologists' time, without compromising patient safety.

Telemedicine in the Northern Territory: an assessment of patient perceptions in the preoperative anaesthetic clinic.

We investigated patient perceptions of a virtual preoperative anaesthesia evaluation clinic linking Royal Darwin Hospital to Katherine Hospital. Descriptive study, cross-sectional survey. Regional and rural areas of Northern Territory, Australia. Sample includes 27 respondents, five Indigenous, 18 non-Indigenous and four unknown. Introduction of a preoperative anaesthesia evaluation clinic. We designed a 10-item, 5-point Likert scale questionnaire assessing patient perceptions in four domains: (i) technical quality; (ii) perceived efficacy; (iii) affective patient experience; and (iv) patient preference. Qualitative responses are also reported. Twenty-seven out of 35 patients (77%) completed the questionnaire. Ninety-eight per cent were in positive agreement on technical quality with a mean score of 1.35 (SD: 0.53); Ninety-five per cent on perceived efficacy, 1.35 (SD: 0.65); Eighty-four per cent in negative agreement on affective patient experience (negative perception item), 4.19 (SD: 1.07); Eighty-one per cent in negative agreement on patient preference (negative perception item), 4.23 (SD: 1.14). There were no significant differences in the answers between Indigenous (five patients) and non-Indigenous patients (18 patients). Our study confirms the acceptability of telemedicine in the remote assessment of preoperative patients in the Northern Territory, with positive perceptions in all four domains.