The Anæsthetic Out‐patient Clinic

Lee, J. Alfred

doi:10.1111/j.1365-2044.1949.tb05837.x

Cited by 75 publications

(14 citation statements)

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“…As demonstrated in this case, a comprehensive preoperative assessment is key to guarantee, to the fullest extent possible, an uneventful surgical procedure. The Preoperative Assessment and Optimization (PAO) is a common practice that has been refined over decades [ 7 , 8 ]. Multiple studies have shown the importance of the PAO in terms of reducing unnecessary testing [ 9 ], case cancellations [ 10 ], and, more importantly, morbidity and mortality [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Complicated Neuraxial Anesthesia in a Patient With Tethered Spinal Cord

Scher¹,

Ayad²

2021

Cureus

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Spinal anesthesia is a common anesthetic used in many surgical procedures. Anatomical variations and diseases make this procedure require extra considerations. Extra care should be taken into consideration in the pre-anesthesia evaluation when neuraxial anesthesia is planned.We present the case of a patient undergoing cesarean section for the arrest of labor, who had a complicated labor course due to unrecognized history of a tethered spinal cord leading to inadequate analgesia, requiring replacement of epidural analgesia and spinal anesthesia. Ultimately, the decision was made to proceed with general anesthesia due to the patient's discomfort. Exhaustive chart review after surgery showed a past MRI with evidence of a tethered spinal cord.

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Section: Discussionmentioning

confidence: 99%

Complicated Neuraxial Anesthesia in a Patient With Tethered Spinal Cord

Scher¹,

Ayad²

2021

Cureus

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“…In the past 50 years the preoperative evaluation has changed from an ad-hoc evaluation to a full physical examination. The ad-hoc evaluation frequently resulted in same-day cancellations or higher perioperative risks if surgery was not postponed 1 . Nowadays, in most countries, the preoperative evaluation is days to weeks before surgery and often led by an anaesthetist 2,3 …”

Section: Introductionmentioning

confidence: 99%

“…The ad-hoc evaluation frequently resulted in same-day cancellations or higher perioperative risks if surgery was not postponed. 1 Nowadays, in most countries, the preoperative evaluation is days to weeks before surgery and often led by an anaesthetist. 2,3 This anaesthetist-led in-person preoperative evaluation is the contemporary standard of care worldwide, with a reported increase in perioperative safety.…”

Section: Introductionmentioning

confidence: 99%

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Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery

Jonker

Heuvel

Hoeks

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDThe design of the optimal preoperative evaluation is a much debated topic, with the anaesthetist-led in-person evaluation being most widely used. This approach is possibly leading to overuse of a valuable resource, especially in low-risk patients. Without compromising patient safety, we hypothesised that not all patients would require this type of elaborate evaluation.OBJECTIVEThe current scoping review aims to critically appraise the range and nature of the existing literature investigating alternatives to the anaesthetist-led preoperative evaluation and their impact on outcomes, to inform future knowledge translation and ultimately improve perioperative clinical practice.DESIGNA scoping review of the available literature.DATA SOURCESEmbase, Medline, Web-of-Science, Cochrane Library and Google Scholar. No date restriction was used.ELIGIBILITY CRITERIAStudies in patients scheduled for elective low-risk or intermediate-risk surgery, which compared anaesthetist-led in-person preoperative evaluation with non-anaesthetist-led preoperative evaluation or no outpatient evaluation. The focus was on outcomes, including surgical cancellation, perioperative complications, patient satisfaction and costs.RESULTSTwenty-six studies with a total of 361 719 patients were included, reporting on various interventions: telephone evaluation, telemedicine evaluation, evaluation by questionnaire, surgeon-led evaluation, nurse-led evaluation, other types of evaluation and no evaluation up to the day of surgery. Most studies were conducted in the United States and were either pre/post or one group post-test-only studies, with only two randomised controlled trials. Studies differed largely in outcome measures and were of moderate quality overall.CONCLUSIONSA number of alternatives to the anaesthetists-led in-person preoperative evaluation have already been researched: that is telephone evaluation, telemedicine evaluation, evaluation by questionnaire and nurse-led evaluation. However, more high-quality research is needed to assess viability in terms of intraoperative or early postoperative complications, surgical cancellation, costs, and patient satisfaction in the form of Patient-Reported Outcome Measures and Patient-Reported Experience Measures.

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“…In 1949, Lee discussed the value of the “anaesthetic outpatient clinic” in the preparation of patients for surgery. [10] Today, an increasing number of pre-anaesthesia assessment clinics (PACs) are supporting hospitals in handling the rise in the number and complexity of surgical procedures. [11] The PAC consultation, conducted by the anaesthesiologist, anaesthesia nurse, or both, is globally recognised as an evaluation method while optimising the patients’ medical condition prior to surgery and anaesthesia, and is considered essential in securing anaesthetic practice since it detects anaesthesia-related risk factors and high-risk patients, improves patient outcomes, prepares the patient physically and psychologically for anaesthesia, and ensures the patient’s most favourable condition for surgery and anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

The effect of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies

Kristoffersen

Opsal

Tveit

et al. 2021

Preprint

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Objectives: The aim of this systematic review was to examine the effectiveness of pre-anaesthetic assessment clinics (PACs) implemented to improve quality and patient safety in perioperative care. Design: Systematic review. Data sources: The electronic databases CINAHL Plus with Full Text (EBSCOhost), Medline, and Embase (OvidSP) were systematically searched from 1st April, 1996 to 4th February, 2021. Eligibility criteria: The main inclusion criterion was that the study, using empirical quantitative methods, addressed the effectiveness of PACs. Data extraction and synthesis: Titles, abstracts, and full texts were screened in duplicate by two authors. Risk of bias assessment, using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies, and data extraction were performed by one author and checked by the other author. Results were synthesised narratively owing to the heterogeneity of the included studies. Results: Seven prospective controlled studies were conducted. Most studies had a high risk of bias. Three studies reported a significant reduction in the length of the hospital stay, and two studies reported a significant reduction in cancellation of surgery for medical reasons when patients were seen in the PAC. In addition, the included studies presented mixed results regarding anxiety in patients. Conclusion: This systematic review demonstrated a reduction in the length of hospital stay and cancellation of surgery when the patients had been assessed in the PAC. There is a need for high-quality prospective studies to gain a deeper understanding of the effectiveness of PACs. PROSPERO registration number: CRD42019137724

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The Anæsthetic Out‐patient Clinic

Cited by 75 publications

References 1 publication

Complicated Neuraxial Anesthesia in a Patient With Tethered Spinal Cord

Complicated Neuraxial Anesthesia in a Patient With Tethered Spinal Cord

Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery

The effect of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies

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