Pre-Anesthesia consultation: objectives and tests you will undergo

Anesthesiology is a constantly evolving medical speciality. Anesthesia is not only the care in the operating theatre, but also covers the preoperative period, postoperative care and pain management. When a patient presents a pathology that requires surgical intervention, he/she is usually referred to a pre-anesthesia consultation. The aim of this consultation is for the anaesthesiologist to perform an adequate preoperative assessment of the patient. With this assessment, the specialist will gather all the information considered relevant about the patient in order to prepare an adequate and individualised anaesthetic plan. The aim is to optimise the patient so that he or she arrives in the operating theatre in the best possible health conditions and thus reduce morbidity and mortality during the operation. We will also clarify any questions and doubts the patient may have.

Objectives of the pre-anesthetic assessment

Establish an adequate doctor-patient relationship: the anaesthesiologist should introduce himself and address any doubts and fears that patients may have. The aim is that the patient arrives at the operation with the greatest possible confidence, security and peace of mind.

Yo know the surgical pathology and associated pathologies of the patient in order to establish an adequate anesthetic plan. This plan is intended to reduce mortality and morbidity and to alleviate the patient’s anxiety.

Obtaining informed consent.

Structure of the pre-anesthesia consultation

MEDICAL HISTORY

The anesthesiologist will start by taking the patient’s medical history. For this purpose, the specialist usually makes use of two things. On the one hand, a review of the patient’s history and, on the other hand, a brief interview with the patient. Thus, in this part of the consultation, it will be very important to obtain as much information as possible from the patient.

The anesthesiologist will ask about allergies or intolerances to drugs or food, coexisting medical conditions that may have implications for the surgery or anaesthesia, medications that the patient has taken or is currently taking and in what dosage. The patient’s family history, the patient’s anaesthetic history (if any) and toxic habits (smoking, alcohol or other substance use) will also be assessed.

PHYSICAL EXAMINATION

Once all this information is available, the specialist will carry out a complete physical examination of the patient, paying special attention to the assessment of the airway, cardiovascular system, respiratory system and neurological system. The patient is usually asked to open their mouth and stick out their tongue and to flex and extend their neck to assess the airway. The patient will be auscultated, weighed and measured and blood pressure will be taken

COMPLEMENTARY TESTS

Finally, the anesthesiologist will assess the complementary tests considered appropriate, always guided by the recommendations of the clinical guidelines. This means that all patients usually undergo a complete blood test, an electrocardiogram and a chest X-ray. However, this is not always the case, as it will depend, among other things, on the pathology of the patient, the type of operation to be performed, the anesthetic risk involved and the patient’s age, among other things. A patient undergoing heart surgery is not the same as a patient undergoing cataract surgery.


The patient’s fear during the pre-anesthesia consultation

The perioperative period is emotionally stressful. Patients often express fears related to both surgery and anesthesia. The most common fears are the fear of not waking up (death), intraoperative awakening (“finding out everything”) or pain. One of the main functions of the anaesthesiologist during the consultation is to reassure the patient. To do so, the patient must be properly informed about everything that is going to be done (type of anaesthesia, how it is administered and how we believe the patient will respond) and all the doubts that may arise must be clarified.

Finally, when the specialist has gathered all the information he/she considers appropriate and has an idea of the patient’s anesthetic risk, he/she will give the patient some recommendations and both of them will sign the informed consent form.

Informed consent in pre-anesthesia consultations

The informed consent is a document that includes an explanation of the anesthetic procedure, its alternatives and all possible complications in terms that the patient can understand. The signature of this document implies that the patient has been duly informed and is aware of both the anesthetic plan and all the possible complications to which he/she is exposed, and that he/she therefore accepts.

Informed consent is obviously signed prior to the operation, but it may be revoked at any time. In other words, the patient always has the right to decide whether or not to undergo surgery or any other procedure requiring anesthesia, even after having signed the consent form.


Questions and recommendations before going for pre-anesthesia consultation

1️⃣ Try to bring a sheet with you with the MEDICATION you take. The specialist usually has access to your history but sometimes there may be a computer problem, for example. Keeping your medication up to date can make the consultation much easier. Also, food supplements, herbs and over-the-counter medications are not usually listed in the history. These are also important and should not be forgotten in the consultation. If you use drugs or other substances, do not try to hide it. The anaesthesiologist is not there to judge you. He or she is only there to help you. Knowing what substances you are taking is necessary to be able to carry out a proper anaesthetic plan.

2️⃣ If you have had a test at another centre or have been admitted to another hospital, try to bring a report with you. This will help your anesthesiologist to review anything he or she thinks is relevant to this procedure.

3️⃣ The anesthesiologist will give you a few HOURS OF FASTING (water and solids) before the operation. Strictly adhere to this recommendation.

4️⃣ It is not necessary to fast before the pre-anaesthesia consultation. The specialist will not perform any invasive test that requires fasting. As we have already mentioned, only an interview and physical examination will be performed.

5️⃣ The anesthesiologist usually DOES NOT KNOW THE DATE OF THE OPERATION. Once the patient comes to the pre-anesthesia consultation, it is hoped that the operation will not take too long, but usually we cannot give a specific date as it is not up to us.

6️⃣ Take as much time as you need for ALL THOSE QUESTIONS AND QUESTIONS. The anesthesiologist will be happy to answer any questions you may have. Remember that the aim of the consultation is for you to leave with all the information you need to relieve any stress you may have.

7️⃣ Doubts about surgical technique, length of hospital stay, medication prescribed by other doctors may not always be resolved by the anesthesiologist. It will often depend on the evolution of the surgery and postoperative period and on the decision of other physicians.

REMEMBER

The anesthesiologist is there to help you. You have come to the pre-anesthesia consultation because you need to undergo surgery. The anesthesiologist is there to make sure that you arrive at the surgery in the best health conditions. They are also there to take care of you during the intraoperative period and to guarantee the best postoperative care. Anesthesiology is a speciality that will look after you during the entire perioperative process.

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