Preanaesthetic assessment and management in the context of the district hospital

Abstract

Preanaesthetic assessment and management allow for the systematic identification of perioperative risks and the implementation of interventions to mitigate them, such that the patient’s physiological state is optimised for surgery or other procedures. This is a crucial activity for good perioperative outcomes, as patients not assessed are at a higher risk of unanticipated adverse perioperative events and are more likely to receive suboptimal management. The district hospitals in South Africa perform minor and moderately complex surgical procedures that require anaesthesia, administered mostly to healthy patients and those with stable diseases without functional limitations. A significant proportion of anaesthesia-related deaths reported in the district hospitals can be linked to poor risk assessment and management. In this article, we highlight the key clinical imperatives for optimal preanaesthetic assessment and management from the district hospital perspective.

Update on preoperative evaluation and optimisation

“…The secondary objective is to advise premedication drugs and perform any interventions required before surgery. [ 1 ] An important requirement for risk assessment is to order investigations on an individual basis and obtain referrals from other specialities. Effective preoperative assessment can decrease delay and postponement of the surgery on the day of surgery.…”

Pre‐anaesthetic assessment and related outcome measures in adults undergoing elective surgery—Scoping review protocol

“…The goals of pre‐anaesthetic assessment are to reduce patient's surgical and anaesthetic risk of perioperative morbidity, mortality and to return the patient to a desirable functioning as quickly as possible. Pre‐anaesthetic assessment includes evaluation of the patient's medical status and ability to tolerate anaesthesia for the planned procedure, obtaining knowledge of the clinical characteristics of the patients, and preparing the patient for the procedure 3,4 …”

“…Pre-anaesthetic assessment includes evaluation of the patient's medical status and ability to tolerate anaesthesia for the planned procedure, obtaining knowledge of the clinical characteristics of the patients, and preparing the patient for the procedure. 3,4 It has been shown that pre-anaesthetic assessment may reduce patient anxiety regarding perioperative care, rate of surgery, cancellation or postponement, and length of hospital stay. 5 Moreover, the omission of pre-anaesthetic assessment is associated with, for example, a higher risk of unanticipated adverse perioperative events and a negative impact on patient outcomes.…”

One nation, one roof, one set of preoperative investigations……The guidelines overcoming a diverse demography!

“…POC testing which can be done at the patient’s bedside or in a satellite laboratory is fast evolving; eg- dipsticks for urine analysis, hand-held glucometers for blood glucose, viscoelastic haemostatic assays withTEG ® 6s for functional fibrinogen level and rapid thromboelastography, instant non-invasive spectrophotometer for haemoglobin, POC tests for pregnancy, blood gases, electrolytes, troponin and infectious diseases. [ 20 21 22 23 ] POC testing though simple, provides results in real-time and is less risky to use, and can be associated with errors. [ 20 ] POC testing may help to minimise preoperative investigations in the future.…”