History of the preanesthesia evaluation: Appreciating the tensions in the anesthesiologist-patient relationship

For the first century of its practice, patients viewed anesthesiology with suspicion. Practitioners debated its professionalization as a medical field and their role in the operating room with the patient. This study looks at the debates around the development and incorporation of a pre-anesthesia evaluation into the patient experience and how these debates shape perceptions about current pre-anesthesia evaluation practices.

We conducted a qualitative descriptive analysis and a narrative synthesis was carried out on archival records of personal papers and paper documents at the Wood Library-Museum of Anesthesiology along with a content review on the history of anesthesia practice and the pre-anesthesia evaluation.

The search for pertinent documents yielded 259 records. Fifty-four additional records were identified manually at the Wood Library-Museum of Anesthesiology. After removing duplicates, excluding non-relevant records, and accessing articles for pertinence, 72 sources were included in the qualitative analysis. Three themes emerged from 72 sources as impacting the evolution of the pre-anesthesia evaluation: growth of the anesthesia workforce, changes in communication in the anesthesiologist-patient relationship, and the patient perspective.

This history is a small, focused look at a part of anesthesia practice today. It reviews some changes over time in the patient-anesthesiologist relationship and covers some of the debates and concerns that arose. Varying viewpoints regarding the practice of anesthesiology and the proper roles of anesthesiologists delayed the requirement for a pre-anesthetic evaluation until 1965, affected its perceived value, and slowed the development of the anesthesiologist-patient relationship. Lack of patient knowledge about the responsibilities of anesthesiologists and the processes for administering anesthesia limits patient understanding of the pre-anesthetic evaluation and the importance of the anesthesiologist-patient relationship. Patient education may improve patient and public understanding of the integral role of anesthesiologists in perioperative management to maintain patient safety.