Anesthesia
From Standard of Care
Anesthesia associated mortality 1 in 200,000 to 400,000 anesthesia procedures.
About 21 million patients given anesthesia annually in the U.S.
Requires a comprehensive preoperative evaluation with a complete history with medication use and prior anesthetic exposure.
Evaluation preoperatively includes exaination of the airway and ability to maintain vascular access.
A complete CBC is the only preoperative testing needed in patients without preexisting disease and under the age of 40 years.
Pre-anesthesia chest x-ray and electrocardiogram should be obtained on individuals 50 years or older or if history or physical examination suggests their indication in younger patients.
Pre-anesthesia pregnancy test should be done on women of childbearing age.
Pre-anesthesia serum electrolytes should be evaluated in patients with diabetes, renal insufficiency and in those who are taking drugs that can alter electrolytes or renal function.
Patients on anticoagulants or with a history of personal bleeding or family history of a bleeding disorder should have a pre-anesthesia PT and PTT.
Pre-anesthesia evaluation must be expanded for individuals with cardiac pulmonary or renal insufficiency.
Customary to abstain from oral intake except for medications with sips of water for 8 hours before elective surgery.
For adults not at risk for aspiration solid foods may be permitted up to 6 hours before surgery, and clear liquids may be taken until 2 hours before surgery.
For patients with slow or incomplete gastric emptying may require longer periods of fasting prior to anesthesia and the use of pretreatment metoclopramide or histamine H2-receptor antagonists.
Cardiovascular or other required medications may be given with sips of water on the morning of surgery.
Insulin dependent diabetics should be switched to sliding scale insulin of the day of surgery.
American Society of Anesthesiologists (ASA) Criteria ASA Grade I-no organic, physiologic biochemical, or psychiatric disturbance: the pathologic prcess for which the operation is to be performed is localized and is not a systemic distrubance. ASA Grade II-mild to moderate systemic distubance caused either by the condition to be treated or by other pathophysiologic processes. ASA Grade III-severe systemic disturbance of disease for whatever cause, even though it may not be possible to define the degree of disability. ASA Grade IV-indicative of the patient with severe systemic disorder that is already life threatening and not always correctable by the operative procedure. ASA Grade V-the moribund patient who has little chance of survival but is submitted to operation in desperation.
