ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

PREOPERERATIVE EVALUATION, PROBLEMS AND SOLUTIONS

Hatice Toprak

Karamanoğlu Mehmetbey University, Faculty of Medicine, Department of Anesthesiology, Karaman, Türkiye

Toprak H. Preopererative Evaluation, Problems and Solutions. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.457-466.

ABSTRACT

  • Preoperative anesthesia assessments are the first step of safe anesthesia for both surgical and non-surgical applications. Perioperative anesthesia assessments increase the quality and efficiency of perioperative care. Determining perioperative risk and suitability for surgery during preoperative anesthesia assessments reduces perioperative mortality and morbidity rates.
  • The basic principles and standard application steps of preoperative anesthesia assessments have been determined by guidelines prepared by professional organizations. According to the guidelines, the detailed medical history of the individual who will undergo surgery, physical examination, medications employed, laboratory and imaging findings must be examined, especially airway assessments. Consultations deemed necessary to optimize preoperative comorbidities for surgery and improve postoperative care must be evaluated. Perioperative risk assessment of the individual who will undergo surgery must be performed.
  • Preoperative anesthesia assessments are accompanied by various difficulties. Negative situations such as being performed in a limited time period, not being able to access past medical records, and the patient focusing on the current surgery and not caring about other medical problems might be encountered. Individuals who will undergo surgery might have specific conditions such as obesity, pregnancy, and fragility.
  • This part will provide information on the basic principles of preoperative anesthesia assessments prepared under the guidance of current guidelines, problems that might occur during the assessment, and their solutions.

Keywords: Perioperative risk; Airway assessments; Preoperative care; Medical records; Safe anesthesia

Referanslar

  1. Chassot PG, Delabays A, Spahn DR. Preoperative Evaluation of Patients with, or at Risk of, Coronary Artery Disease Undergoing Non-Cardiac Surgery. Br. J. Anaesth. 2002;89(5):747-759. [Crossref]  [PubMed]
  2. Tobias JD. Preoperative Anesthesia Evaluation. Semin. Pediatr. Surg. 2018;27(2):67-74. [Crossref]  [PubMed]
  3. De Hert S, Staender S, Fritsch G, Hinkelbein J, Afshari A, Bettelli G, et al. Pre-Operative Evaluation of Adults Undergoing Elective Noncardiac Surgery: Updated Guideline from the European Society of Anaesthesiology. Eur. J. Anaesthesiol. EJA 2018;35(6):407. [Crossref]  [PubMed]
  4. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S, et al. 2014 ESC/ESA Guidelines on Non-Cardiac Surgery: Cardiovascular Assessment and Management: The Joint Task Force on Non-Cardiac Surgery: Cardiovascular Assessment and Management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur. J. Anaesthesiol. EJA 2014;31(10):517. [Crossref]  [PubMed]
  5. Intensivmedizin GE, der DG. für A. und; Medizin, der D. G. für C. und der D. G. für I. Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen1*. AINS - Anästhesiol. · Intensivmed. · Notfallmedizin · Schmerzther. 2017;52:446-462. [Crossref]  [PubMed]
  6. Kagerbauer SM, Wißler J, Andonov DI, Ulm B, Schneider G, Podtschaske AH, et al. Implementation of a Software-Based Decision Support Tool for Guideline-Appropriate Preoperative Evaluation: A Prospective Agreement Study. BJA Br. J. Anaesth. 2024;133(3):519-529. [Crossref]  [PubMed]  [PMC]
  7. Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, Beeck EF. van. Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care. Infect. Control Hosp. Epidemiol. 2010;31(3):283-294. [Crossref]  [PubMed]
  8. Bion JF, Abrusci T, Hibbert P. Human Factors in the Management of the Critically Ill Patient. Br. J. Anaesth. 2010;105(1):26-33. [Crossref]  [PubMed]
  9. Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors Influencing the Implementation of Clinical Guidelines for Health Care Professionals: A Systematic Meta-Review. BMC Med. Inform. Decis. Mak. 2008;8:38. [Crossref]  [PubMed]  [PMC]
  10. Pang CL, Gooneratne M, Partridge JSL. Preoperative Assessment of the Older Patient. BJA Educ. 2021;21(8):314-320. [Crossref]  [PubMed]  [PMC]
  11. Čolak Ž, Pavlek M, Mažar M, Konosić S, Ivančan V, Bevanda M. Preoperative Anaesthesiologic Evaluation of Patient with Known Allergy. Psychiatr. Danub. 2019;31(5); 745-749. [PubMed]
  12. Komurcu O, Genc C, Kurt BC, Demir O, Akbaş A, Akyurt D, et al. Preoperative Evaluation: Impact on Early Perioperative Hemodynamic and Respiratory Complications. BMC Anesthesiol. 2024;24:435. [Crossref]  [PubMed]  [PMC]
  13. Barbeito A, Raghunathan K, Connolly S, Mariano ER, Blitz J, Stafford RS, Mudumbai S. Barriers to Implementation of Telehealth Pre-Anesthesia Evaluation Visits in the Department of Veterans Affairs. Fed. Pract. 2023;40(7):210-217. [Crossref]  [PubMed]  [PMC]
  14. De Cassai A, Boscolo A, Tonetti T, Ban I, Ori C. Assignment of ASA-Physical Status Relates to Anesthesiologists' Experience: A Survey-Based National-Study. Korean J. Anesthesiol. 2019;72(1):53-59. [Crossref]  [PubMed]  [PMC]
  15. Günaydın, B. ASA Fiziksel Durum Sınıflandırma Sistemi. Turk. J. Anaesthesiol. Reanim. 2021:49(2);192-193. [PMC]
  16. Mayhew D, Mendonca V, Murthy BVS. A Review of ASA Physical Status - Historical Perspectives and Modern Developments. Anaesthesia 2019;74(3):373-379. [Crossref]  [PubMed]
  17. Practice Advisory for Preanesthesia Evaluation: An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 2012;116(3):522-538. [Crossref]  [PubMed]
  18. Blitz JD, Kendale SM, Jain SK, Cuff GE, Kim JT, Rosenberg AD. Preoperative Evaluation Clinic Visit Is Associated with Decreased Risk of In-Hospital Postoperative Mortality. Anesthesiology 2016;125(2):280-294. [Crossref]  [PubMed]
  19. Lemmens L C, Kerkkamp HE. Klei WA. van Klazinga NS. Rutten CL. Linge RH. van; Moons KG. Implementation of Outpatient Preoperative Evaluation Clinics: Facilitating and Limiting Factors. Br. J. Anaesth. 2008;100(5):645-651. [Crossref]  [PubMed]
  20. Schiff JH, Frankenhauser S, Pritsch M, Fornaschon SA, Snyder-Ramos SA, Heal C, et al. The Anesthesia Preoperative Evaluation Clinic (APEC): A Prospective Randomized Controlled Trial Assessing Impact on Consultation Time, Direct Costs, Patient Education and Satisfaction with Anesthesia Care. Minerva Anestesiol. 2010;76(7) 491-499. [PubMed]
  21. Flamm M, Fritsch G, Hysek M, Klausner S, Entacher K, Panisch S, Soennichsen AC. Quality Improvement in Preoperative Assessment by Implementation of an Electronic Decision Support Tool. J. Am. Med. Inform. Assoc. 2013;20 (1):91-96. [Crossref]  [PubMed]  [PMC]
  22. Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, et al. Self-Reported Exercise Tolerance and the Risk of Serious Perioperative Complications. Arch. Intern. Med. 1999;159(18). [Crossref]  [PubMed]
  23. Mirle G, Edwin Jr MD, FCCP a Olaf D, MS Victor Pinto-Plata MD a Bartolome C, FCCP . Symptom-Limited Stair Climbing as a Predictor of Postoperative Cardiopulmonary Complications after High-Risk Surgery. Chest 2001;120(4). [Crossref]  [PubMed]
  24. Updated by the Committee on Standards and Practice Parameters; Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. The previous update was developed by the American Society of Anesthesiologists Task Force on Difficult Airway Management; . Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118(2):251-270. [Crossref]  [PubMed]
  25. Braz LG, Braz DG, Cruz DS, da Fernandes LA, Módolo NSP, Braz JRC. Mortality in Anesthesia: A Systematic Review. Clinics 2009;64(10):999-1006. [Crossref]  [PubMed]  [PMC]
  26. Xia M, Ma W, Zuo M, Deng X, Xue F, Battaglini D, et al. Expert Consensus on Difficult Airway Assessment. Hepatobiliary Surg. Nutr. 2023;12(4):545-566. [Crossref]  [PubMed]  [PMC]
  27. Mallampati SR, Gatt SP, Gugino LD, Desai SP, WaraksaB.; Freiberger D, Liu PLA Clinical Sign to Predict Difficult Tracheal Intubation: A Prospective Study. Can. Anaesth. Soc. J. 1985;32(4):429-434. [Crossref]  [PubMed]
  28. Paxton E, Parotto M. The Best Visible Mallampati ScoreToo Good to Be True? Can. J. Anesth. Can. Anesth. 2024;71(10),:133-1343. [Crossref]  [PubMed]
  29. Gl S, Jr Y. Difficult Tracheal Intubation: A Retrospective Study. Anaesthesia 1987;42(5). [Crossref]  [PubMed]
  30. Boutonnet M, Faitot V, Katz A, Salomon L, Keita H. Mallampati Class Changes during Pregnancy, Labour, and after Delivery: Can These Be Predicted? Br. J. Anaesth. 2010:104(1):67-70. [Crossref]  [PubMed]
  31. Lamperti M, Romero CS, Guarracino F, Cammarota G, Vetrugno L, Tufegdzic B, et al. Preoperative Assessment of Adults Undergoing Elective Noncardiac Surgery: Updated Guidelines from the European Society of Anaesthesiology and Intensive Care. Eur. J. Anaesthesiol. EJA 2025;42(1):1. [Crossref]  [PubMed]
  32. Zeng S, Qing Q, Xu W, Yu S, Zheng M, Tan H, Peng J, Huang J. Personalized Anesthesia and Precision Medicine: A Comprehensive Review of Genetic Factors, Artificial Intelligence, and Patient-Specific Factors. Front. Med. 2024;11:1365524. [Crossref]  [PubMed]  [PMC]
  33. Moon TS, Fox PE, Somasundaram A, Minhajuddin A, Gonzales MX, Pak TJ. Ogunnaike, B. The Influence of Morbid Obesity on Difficult Intubation and Difficult Mask Ventilation. J. Anesth. 2019;33(1):96-102. [Crossref]  [PubMed]
  34. Cordes SR, Best AR, Hiatt KK. The Impact of Obesity on Adult Tracheostomy Complication Rate. The Laryngoscope 2015;125(1):105-110. [Crossref]  [PubMed]
  35. Party MW, Nightingale CE, Margarson MP, ShearerE, Redman JW, Lucas DN, et al. Peri-Operative Management of the Obese Surgical Patient 2015. Anaesthesia 2015;70(7):859-876. [Crossref]  [PubMed]  [PMC]
  36. Nagappa M, Patra J, Wong J, Subramani Y, Singh M, Ho G, Wong DT, Chung F. Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-Analysis of Prospective and Retrospective Cohort Studies. Anesth. Analg. 2017;125(4):1301-1308. [Crossref]  [PubMed]
  37. Rafiq A, Sklyar E, Bella JN. Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery. Health Serv. Insights 2017;9:1178632916686074. [Crossref]  [PubMed]  [PMC]
  38. Lm V, Wa van K, Kg M, TT, J van W, Ja D. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst. Rev. 2021;12(12). [Crossref]  [PubMed]  [PMC]
  39. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation 1999;100(10): 1043- 1049. [Crossref]  [PubMed]
  40. Hughes C, Ackland G, Shelley B. Perioperative Myocardial Injury. BJA Educ. 2024;24(10):352-360. [Crossref]  [PubMed]
  41. Mokhtar AT, Tennankore K, Doucette S, Herman CR. Predicting Acute Kidney Injury Following Nonemergent Cardiac Surgery: A Preoperative Scorecard. J. Card. Surg. 2021;36(7):2204-2212. [Crossref]  [PubMed]
  42. Renal Disease: The Anesthesiologist's Perspective. Anesthesiol. Clin. N. Am. 2006;2(3):523-547. [Crossref]  [PubMed]
  43. Brentjens TE, Chadha R. Anesthesia for the Patient with Concomitant Hepatic and Renal Impairment. Anesthesiol. Clin. 2016;34(4):645-658. [Crossref]  [PubMed]
  44. Surgery in the Patient With Liver Disease. Mayo Clin. Proc. 1999;74(6):593-599. [Crossref]  [PubMed]
  45. Kalo E, George J, Read S, Majumdar A, Ahlenstiel G. Evolution of Risk Prediction Models for Post-Operative Mortality in Patients with Cirrhosis. Hepatol. Int. 2023;17(3):542-545. [Crossref]  [PubMed]  [PMC]
  46. Starczewska MH, Mon W, Shirley P. Anaesthesia in patients with liver disease. Curr. Opin. Anesthesiol. 2017;30(3):392. [Crossref]  [PubMed]
  47. Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol Infusion Syndrome: A Structured Literature Review and Analysis of Published Case Reports. BJA Br. J. Anaesth. 2019;122(4):448-459. [Crossref]  [PubMed]  [PMC]
  48. Sharma NR, Basne A, Lamichhane S, Tiwari K, Varghese J, Gautam S, Pokhrel M. Sphincter of Oddi Dysfunction Induced by Ketamine: A Case Report. Clin. Case Rep. 2024;12(6):9016. [Crossref]  [PubMed]  [PMC]
  49. Hoetzel A, Ryan H, Schmidt R. Anesthetic considerations for the patient with liver disease. Curr. Opin. Anesthesiol. 2012;25(3):340. [Crossref]  [PubMed]
  50. Fried M, Dolezalova K, Buchwald JN, McGlennon TW, Sramkova P, Ribaric G. Laparoscopic Greater Curvature Plication (LGCP) for Treatment of Morbid Obesity in a Series of 244 Patients. Obes. Surg. 2012;22(8):1298-1307. [Crossref]  [PubMed]
  51. Becerra-Bolaños Á, Hernández-Aguiar Y, Rodríguez-Pérez A. Preoperative Frailty and Postoperative Complications after Non-Cardiac Surgery: A Systematic Review. J. Int. Med. Res. 2024;52(9):03000605241274553. [Crossref]  [PubMed]  [PMC]
  52. Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and Perioperative Outcomes: A Narrative Review. Can. J. Anesth. Can. Anesth. 2015;62(2):143-157. [Crossref]  [PubMed]