Anesthesiology update: the preanesthetic evaluation

Ideal anesthetic management consists of the preanesthetic attainment of a state in which a diagnostic or therapeutic procedure or surgical operation can be performed with as little physiologic and psychologic trauma as possible, and the likelihood of a speedy and uneventful postoperative course is enhanced. Significant impairment of cardiovascular, respiratory, renal and other organ system functions is common in patients facing surgery. Thus, it is imperative that preoperative evaluation be complete. Signs of congestive heart failure, myocardial ischemia or infarction or both, hypertension, electrolyte abnormalities, and cardiac arrhythmias should be aggressively sought and treated before surgery. In addition, before the induction of anesthesia, information must be obtained about the specific associated pathologies (cardiac and otherwise), drugs being used to treat these conditions, and the adequacy of the current therapies. The preoperative evaluation does not begin with the anesthesiologist's visit, but with the evaluation and care given by the primary physician. A team approach is advisable in complex cases. Appropriate consultations, including that of the anesthesiologist, should be made in a timely fashion. Except in emergency situations, the temptation to send incompletely evaluated and treated patients to the operating room should be resisted. Good preoperative preparation will improve the chances for a successful outcome.