Pre-Anesthesia Screening

Purpose & Goal  

The purpose and overall goal of Pre-Anesthesia Screening (PAS) is to gather the clinical information necessary for the safe and effective administration of anesthesia through a process that is convenient for patients and physicians and results in efficient surgical throughput.

The Need for Pre-Anesthesia Screening  

1. With the shift to ambulatory surgery and same-day admissions, as many as 90% of a hospital's patients don't arrive at the facility until the day of their
surgery.
2. This makes it more difficult for nurses and anesthesiologists to get the information they need about patients and to initiate any remedial action (e.g., lab testing, cardiology consults, x-ray exams) warranted by patients’ condition.
3. Oftentimes the results are delays, postponements, and cancellations of scheduled surgery with patients and family being dissatisfied and physicians and staff being unproductive.
4. Develop a matrix combining patients' health status and scheduled procedure severity with the appropriate diagnostic response
5. Develop an interview guide to elicit patient conditions triggering additional diagnostic interventions

Functions of the PAS Process  

• Assess patients' medical status as soon as they are scheduled for surgery
• If needed, obtain diagnostic tests to medically screen patients
• Identify potential patients at risk
• Increase patient confidence in how to prepare, what to expect and what they will physically encounter during their surgical stay and how that may affect their care after surgery
• Inform patients about the risks and benefits of different types of anesthesia
  - Provide patient-specific instructions (meds, diet) for the day of surgery
  - Initiate post-op care expectations for patients and their families

How the PAS Process Should Work  

Steps to Establish a PAS Process  

1. Form a multidisciplinary committee (anesthesiologists, PAS nurse, pathologist, radiologist, cardiologist)
2. Identify patient health conditions indicating:
3. Identify surgical procedures creating risks independent of patients' underlying health status
   a. Need for additional diagnostics (x-ray, labs, ECG)
   b. Need for specialist consultation (cardiology)
   c. Need for anesthesiologist interview

Patient Health Conditions Indicating Need for an "In Person" PAS Visit

General Health Status  

• Inhibited ability to engage in normal daily activity
• Requires continuous monitoring at home
• Recent admission (2 months) for acute condition or exacerbation of a chronic condition
• Past or family history of problem with anesthesia
• Personal or family history of malignant hyperthermia
• Morbid obesity (BMI > 35)

Cardiovascular

• History of angina, coronary artery disease, myocardial infarction
• Symptomatic arrhythmias
• Poorly controlled hypertension (diastolic > 110; systolic > 160)
• History of congestive heart failure

Respiratory

• Asthma, COPD requiring medication or with acute exacerbation and progression within the past six months
• History of major airway surgery or unusual airway anatomy
• Upper or lower airway tumor or obstruction
• Home ventilatory assistance
• Morbid obesity (BMI > 35)

Endocrine

• Non-diet controlled diabetes (insulin or oral hypoglycemic agents)
• Adrenal disorders
• Active thyroid disease

Hepatic

• Any active hepatobiliary disease or compromise

Oncologic

• Currently undergoing course of chemotherapy
• Onocologic process with significant physiologic compromise

Neuromuscular

• History of seizure disorder or other significant central nervous system disease (multiple sclerosis, myasthenia gravis)
• History of myopathy or other muscle disorders

Musculoskeletal

Kyphosis or scoliosis causing functional compromise

• Temporomandibular joint disorder
• Cervical or thoracic spine injury

Gastrointestinal

• Hiatal hernia
• Symptomatic gastroesophageal reflux

Anesthesia Testing Guidelines  

High Risk Surgical Procedures  

Sample Elements of PAS Interview Guide
Basic Demographic Information  

History of Past Medical Conditions  

History of Past Health Habits  

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Current Health History  

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Current Medication History  

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Surgical History  

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Anesthesia History