Minimal sedation maximized
Minimal Sedation (Anxiolysis) – a drug-induced (produced) state during which patients respond normally to oral commands. Although mental function and coordination may be impaired, respiratory (breathing) and cardiovascular (blood pressure, pulse) functions are unaffected.
Moderate Sedation [Conscious (Awake) Sedation] – a drug-generated depression of consciousness during which patients respond purposefully to oral commands, either alone or accompanied by light touch stimulation. No assistance are required to maintain breathing. Cardiovascular function is usually maintained.
The ultimate goals of preoperative medical examination are to reduce the patient’s surgical and anesthetic complications during and after the procedure and to return him to desirable functioning as quickly as possible. It is essential to realize that operative and post-surgery risk is multifactorial. A history and physical examination, focusing on risk factors for cardiac and lungs complications are essential to any preoperative evaluation.
Laboratory investigations are ordered only when indicated by the patient’s medical status, drug treatment, or the nature of the proposed procedure and not on a routine basis.
It is well recognized that safe and efficient anesthesia practice requires an optimized patient.
The following primary goals of preoperative evaluation and preparation have been identified.
- Documentation of the condition(s) for which surgery is needed.
- Assessment of the patient’s overall health status.
- Uncovering of hidden conditions that could cause problems both during and after surgery.
- Perioperative (during and after surgery) risk determination.
- Optimization of the patient’s medical condition in order to reduce the patient’s surgical and anesthetic perioperative complications.
- Development of an appropriate perioperative care plan.
- Education of the patient about anesthesia.
- The History:
- The history is the most important component of the preoperative evaluation. The history includes a past and current medical history, a surgical history, a family history, a history of allergies, current and recent drug therapy, unusual reactions or responses to drugs and any problems or complications associated with previous anesthetics.
- Diseases of the heart, blood pressure and respiratory systems are the most relevant in respect of fitness for anesthesia and surgery
- Physical Examination: The physical examination is built on the information gathered during the history. At a minimum, a focused preanesthesia physical examination includes an assessment of the airway, lungs and heart, with documentation of heart arte, blood pressure and breathing rate. Unexpected abnormal findings on the physical examination is investigated before elective surgery.
- Laboratory work up: It is generally accepted that the clinical history and physical examination represent the best method of screening for the presence of disease. Routine laboratory tests in patients who are apparently healthy on clinical examination and history are not beneficial or cost effective.
Lab tests are ordered based on information obtained from the history and physical examination.
- Drug History:
- A history of medication is obtained in all patients. Generally, administration of most drugs is continued up to and including the morning of operation, although some adjustment in dosage may be required (e.g. antihypertensive (Blood pressure medication), insulin).
- Some drugs are discontinued preoperatively.
- The use of medications that potentiate bleeding needs to be evaluated closely.