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Anesthesia
Anesthesia and Pain Medicine

Pre-Anesthesia Assessment Clinic

Background | Rationale | Co-existing conditions | Further testing and evaluation | Physical exam | Anesthetic planning


 

Background

Our clinic provides comprehensive pre-anesthesia patient evaluations, information and patient education about the surgical - anesthetic process, risks, and alternatives.  Each patient is carefully assessed by a team of nurses and physicians.  The anesthesiologist is the perioperative physician who provides medical care to patients throughout their surgical experience. This spectrum of care includes the medical evaluation of patients before surgery, consulting with the surgical team and providing pain control and support of life functions during surgery, supervising care after surgery, and medically discharging a patient from a recovery unit. In addition, anesthesiologists provide sedation and anesthesia for patients undergoing medical and diagnostic procedures.

Rationale

The reason for visiting the Pre-Anesthesia Assessment Clinic is to ensure that your child’s overall medical condition is the best it can be prior to encountering the stresses of anesthesia and surgery. Given the position the anesthesiologist occupies as a perioperative physician, this person is uniquely qualified to assess, from a medical standpoint, your child’s fitness to undergo anesthesia and surgery. The consultation identifies and seeks to minimize patient and surgical factors contributing to the overall risk. 

The process also helps to reduce economic loss or inconvenience to patients, parents, physicians, nursing and hospital staff by avoiding delays and cancellations.  In addition, some patients/parents have special questions and concerns that are best addressed by an anesthesiologist.

Co-existing conditions

The most common problems that need further medical evaluation in surgical patients are cardiac (heart) and pulmonary (lung) diseases. Surgery and anesthesia can be very stressful, and coupled with the above diseases, can lead to adverse outcomes that can threaten patients’ well being, or even their lives. Obviously, a variety of patients with many different diseases still need and receive operations. Thus, a major goal of the perioperative physician is to diagnose and treat any coexisting medical conditions, so as to minimize the risk of adverse outcomes.

Further testing and evaluation may be ordered

Other diseases that may lead to adverse events if not well-controlled at the time of surgery, include diseases of the liver, kidneys, nervous system, musculoskeletal system, endocrine system (example: diabetes, thyroid disease) and hematological (blood) system. Based on the information obtained by the physician in the Pre-Anesthesia Assessment Clinic, your child may need to undergo further testing, consultation, or therapy in order to optimize their health and minimize their risk when undergoing their procedure. Blood samples may need to be taken or x-rays performed in order to further clarify a given medical condition. 

Sometimes, special tests need to be ordered to determine the function of your child’s heart, lungs, or other organ system. Your child may also be referred to various medical specialists for diagnosis and treatment if necessary. If your child’s surgery is elective and they have an unstable medical condition, surgery may be delayed, so that their condition can be better evaluated and treated.

Physical examination

Your child will undergo a brief physical exam by the nurse and physician in the clinic with special emphasis on aspects of your child’s health that are pertinent to the administration of anesthesia. One area of particular concern to anesthesiologists is examination of the airway (mouth, throat, voice box and windpipe). Often, the anesthesiologist must provide breathing support for the anesthetized patient, and must have a means of delivering oxygen and anesthetic gases into the airway. It is crucial that we recognize any abnormalities of the airway early, so that we may make plans for management during your child’s operation. Your anesthesiologist may also conduct a physical examination directed to the lung and heart function.

The Anesthetic Plan

Finally, your anesthesiologist will formulate an anesthetic plan for your child’s surgery. This plan will take into account your child’s surgical procedure, any medical conditions they have, and their history of previous anesthetics combined with their particular likes and dislikes. Your child’s anesthesiologist will discuss this plan with you during your visit, and will answer your questions. Often, the physician who evaluates your child in the clinic will not be the one who delivers your child's anesthetic on the day of surgery. In all cases, a complete pre-anesthetic record will be forwarded to the anesthesiologist attending to the case, well in advance of your child’s surgery date. 

Because different anesthesiologists have differing preferences in their practice, there is often more than one way to successfully provide for your child’s comfort and safety during their operation.  Hence, the physician who sees your child in the clinic may discuss more than one anesthetic technique and the final decision will be left to the physician who delivers the anesthetic, in consultation with you.

 

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