Importance of Pre-Anesthetic Check-up
A pre-anesthetic check-up is essential to patient safety as it helps identify potential risks, optimize patient condition before surgery, and prevent anesthetic misadventures that could lead to hypoxic brain damage or death. 1
Key Components and Benefits of Pre-Anesthetic Evaluation
Patient Safety and Risk Assessment
- Detects concomitant diseases that might influence anesthetic management 2
- Identifies specific risk factors like obstructive sleep apnea that require special anesthetic considerations 3
- Allows for optimization of patient condition before surgery, especially for cardiovascular and respiratory systems which are most commonly associated with increased anesthetic risk 2
Equipment Safety Verification
- Ensures proper functioning of all anesthetic equipment before use 1
- Prevents equipment-related complications during anesthesia 4
- Confirms availability of backup systems and alternative ventilation equipment 5
Clinical Decision-Making Benefits
- Enables appropriate anesthetic technique selection based on patient condition
- Facilitates planning for potential complications
- Allows for discussion of risks with patients and obtaining informed consent 3
- May lead to reconsideration of surgical approach or timing when significant risks are identified 3
Pre-Anesthetic Check Protocol
Equipment Checks
Anaesthetic machine verification: Must be performed at the beginning of each operating session 1
- Gas supplies and suction
- Breathing system integrity
- Vaporizers and ventilator settings
- Alarms and monitoring systems
Two-bag test: Should be performed after checking breathing system, vaporizers and ventilator individually 1
Documentation: A record must be kept with the anaesthetic machine that these checks have been done 1
Patient Assessment
- History and physical examination are most valuable for detecting anesthesia-relevant abnormalities 2
- For patients over 60, additional screening tests may be useful 2
- Special attention to cardiovascular and respiratory systems as they present the highest risk 2
Special Considerations
High-Risk Conditions
- Obstructive sleep apnea requires careful evaluation and may warrant reconsideration of surgical approach or anesthetic technique 3
- Class II obesity and hypertension increase anesthetic risks and require thorough pre-anesthetic assessment 3
Training and Competency
- Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so 1
- Hospitals must ensure all personnel are trained to use and check relevant equipment 1
- Records of training must be maintained 1
Common Pitfalls and How to Avoid Them
- Insufficient equipment checking: Use standardized checklists and document completion 4
- Relying solely on routine tests: Clinical history and examination are more important than routine preoperative tests 6
- Neglecting "first user" check after servicing: This check is especially important and must be recorded 1
- Failure to have backup plans: A self-inflating bag must be immediately available in any location where anesthesia may be given 1
- Overlooking patient-specific risks: Thorough clinical preoperative assessment is crucial for identifying individual risk factors 6
By conducting comprehensive pre-anesthetic evaluations, anesthesia providers can significantly reduce morbidity and mortality while ensuring optimal patient outcomes.