Role of Preanaestethic Clinic

Role of pre-anaesthetic clinic • • • • • • • • • Aims to assess the pre-operative risk and minimise that risk. - It does this by producing a personalised plan. This may involve: ✓ Alteration to the original surgical plan. ✓ Medical and social optimisation. ✓ Specific pre-operative interventions. ✓ Drug commencement and cessation. ✓ Decision on the level of post operative care. It educates the patient about the process choices, expectations of the surgical episode to support informed consent and active participation. Ensures that the patient’s state of health has been optimised. Preparing a plan of perioperative management. Allowing discussion with patient and/or guardian. Obtaining informed consent for the anaesthesia and related procedures. Should not be omitted unless the patient welfare is at risk. For example, when an emergency surgery is required ASAP. The extent of assessment process differs depending on urgency, magnitude of surgery and intended anaesthetic technique. General principles: - - - Even if a preliminary one has been conducted by another person, the practitioner administering the anaesthesia should be satisfied that all elements of the assessment have been satisfied and if in doubt about any elements then these should be repeated. consultation should take place at a time prior to the anaesthesia and the planned procedure that allows for adequate consideration of all factors related to assessment and optimisation for surgery, anaesthesia, and pain management. This includes obtaining information about medical history, which may require liaising with hospital pharmacists and clinicians from other disciplines involved in the management of patients. This is especially important where: ✓ there is a significant patient co-morbidity. ✓ Major surgery is planned. ✓ There are specific anaesthesia and plan management concerns. The consultation should include: ✓ Identification and introduction of the medical practitioner performing the consultation. ✓ Confirmation with the patient of their identity, the purpose of the procedure and the proceduralist involved. ✓ A medical assessment of the patient including relevant medical history, which may be assisted by a questionnaire and/or review of the relevant patient records, clinical examination, review of the medications and review of the results of the investigations. ✓ A summary of the general medical status by relevant systems and diseases including the comorbidities and ASA risk classification. ✓ Results of relevant laboratory data and investigations. ✓ Concurrent therapy. ✓ Physical examination of the patient including assessment of the airway and dental condition. ✓ A special attention is to be paid to any history of anaphylaxis or serious drug reactions as well as the presence of any cardiac implantable electric device. ✓ Consideration if further investigations and/or therapeutic interventions may be considered necessary to optimise the patient’s physical status and mental wellbeing. ✓ Review of pervious anaesthesia records (may be necessary to obtain from another medical facility). ✓ Consultation with professional colleagues if required. ✓ Consideration of the facilities, equipment, and staffing with respect to the proposed procedure and patient co-morbidities to ensure that appropriate levels of care are available throughout the patient admission: preoperative, intraoperative and postoperative. ✓ Providing the patient any information of significance in a timely manner. ✓ Obtaining informed consent where required. ✓ Provision of information regarding medication management and ordering/modification/cessation of any additional medications considered necessary. ✓ Fasting instructions. ✓ Provision of any further information such as discharge requirements. ✓ Education on modifiable health factors for optimisation such as encouraging patients to quit smoking. ✓ The pre-anaesthesia consultation should identify and take note of any advanced care directives.