Abstract
Intraoperative anesthetic care is dictated by a number of factors. An understanding of the patient’s medical status and reserve is critical in the planning and administration of a successful anesthetic that idealizes surgical conditions while optimizing patient safety. The preoperative evaluation and medical optimization of the patient presenting for otolaryngology procedures is central to the role of the anesthesiologist, and it is essential that all otolaryngologists have a working knowledge of the concepts and importance of the preoperative patient assessment. While the focus of this chapter is medical in nature, the psychological and potential medical-legal importance of a thorough preoperative visit cannot be overstated. Most patients admit to being more frightened of the anesthetic than the surgery and the ability of the anesthesiologist to gain the patient’s trust and alleviate their anxiety while simultaneously obtaining a pertinent anesthetic history and physical, and informing them of the likely risks and benefits of the proposed anesthetic and monitoring, is equally important as is administering sound intraoperative care.
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References
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American society of echocardiography, American society of nuclear cardiology, heart rhythm society, society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, society for vascular medicine and biology, and society for vascular surgery. J Am Coll Cardiol. 2007;50:1707–32.
Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.
Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353:349–61.
Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003;107:149–58.
Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American college of cardiology/american heart association task force on practice guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American college of chest physicians and the international society for heart and lung transplantation: endorsed by the heart rhythm society. Circulation. 2005;112:e154–235.
Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47.
Dunkelgrun M, Boersma E, Schouten O, et al. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg. 2009;249:921–6.
Howell SJ, Sear JW, Foex P. Hypertension, hypertensive heart disease and perioperative cardiac risk. Br J Anaesth. 2004;92:570–83.
Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009;76 Suppl 4:S126–32.
Rosenman DJ, McDonald FS, Ebbert JO, Erwin PJ, LaBella M, Montori VM. Clinical consequences of withholding versus administering renin-angiotensin-aldosterone system antagonists in the preoperative period. J Hosp Med. 2008;3:319–25.
Tirumalasetty J, Grammer LC. Asthma, surgery, and general anesthesia: a review. J Asthma. 2006;43:251–4.
Rock P, Passannante A. Preoperative assessment: pulmonary. Anesthesiol Clin North Am. 2004;22:77–91.
Silvanus MT, Groeben H, Peters J. Corticosteroids and inhaled salbutamol in patients with reversible airway obstruction markedly decrease the incidence of bronchospasm after tracheal intubation. Anesthesiology. 2004;100:1052–7.
Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–55.
Shafazand S. Perioperative management of obstructive sleep apnea: ready for prime time? Cleve Clin J Med. 2009;76 Suppl 4:S98–103.
Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.
Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American society of anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Anesthesiology 2006;104:1081–93; quiz 117–8.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67.
Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.
Moghissi ES, Korytkowski MT, DiNardo M, et al. American association of clinical endocrinologists and American diabetes association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–31.
Kavanagh BP, McCowen KC. Clinical practice. Glycemic control in the ICU. N Engl J Med. 2010;363:2540–6.
Udelsman R, Norton JA, Jelenich SE, et al. Responses of the hypothalamic-pituitary-adrenal and renin-angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress. J Clin Endocrinol Metab. 1987;64:986–94.
Salem M, Tainsh Jr RE, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219:416–25.
Goodman LS, Gilman A, Brunton LL, Lazo JS, Parker KL. Goodman & Gilman’s the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill; 2006.
Rizvon MK, Chou CL. Surgery in the patient with liver disease. Med Clin North Am. 2003;87:211–27.
Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:299S–339.
Jaffer AK. Perioperative management of warfarin and antiplatelet therapy. Cleve Clin J Med. 2009;76 Suppl 4:S37–44.
Newsome LT, Weller RS, Gerancher JC, Kutcher MA, Royster RL. Coronary artery stents: II. Perioperative considerations and management. Anesth Analg. 2008;107:570–90.
Tomar SL. Trends and patterns of tobacco use in the United States. Am J Med Sci. 2003;326:248–54.
Warner DO. Preoperative smoking cessation: how long is long enough? Anesthesiology. 2005;102:883–4.
Kaplan ED, Rozen WM, Shayan R, et al. Preventing postoperative haematomas in microvascular reconstruction of the head and neck: lessons learnt from 126 consecutive cases. ANZ J Surg. 2008;78:383–8.
Clark JR, McCluskey SA, Hall F, et al. Predictors of morbidity Âfollowing free flap reconstruction for cancer of the head and neck. Head Neck. 2007;29:1090–101.
Marin VP, Pytynia KB, Langstein HN, Dahlstrom KR, Wei Q, Sturgis EM. Serum cotinine concentration and wound complications in head and neck reconstruction. Plast Reconstr Surg. 2008;121:451–7.
Garces YI, Schroeder DR, Nirelli LM, et al. Tobacco use outcomes among patients with head and neck carcinoma treated for nicotine dependence: a matched-pair analysis. Cancer. 2004;101:116–24.
Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM. Prevalence, detection, and treatment of alcoholism in hospitalized patients. JAMA. 1989;261:403–7.
Moller AM, Villebro N, Pedersen T, Tonnesen H. Effect of Âpreoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359:114–7.
Yang GP, Longaker MT. Abstinence from smoking reduces incisional wound infection: a randomized, controlled trial. Ann Surg. 2003;238:6–8.
Nakagawa M, Tanaka H, Tsukuma H, Kishi Y. Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after Âpulmonary surgery. Chest. 2001;120:705–10.
Warner MA, Divertie MB, Tinker JH. Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients. Anesthesiology. 1984;60:380–3.
Hald J, Overgaard J, Grau C. Evaluation of objective measures of smoking status–a prospective clinical study in a group of head and neck cancer patients treated with radiotherapy. Acta Oncol. 2003;42:154–9.
Tonnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg. 1999;86:869–74.
Tonnesen H, Rosenberg J, Nielsen HJ, et al. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. BMJ. 1999;318:1311–6.
Spies CD, Nordmann A, Brummer G, et al. Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract. Acta Anaesthesiol Scand. 1996;40:649–56.
Ethical Guidelines for the Anesthesia Care of Patients with Do-ÂNot-Resuscitate Orders or Other Directives that Limit Treatment. 2008. Accessed at www.asahq.org/publicationsAndServices/Âstandards/09.pdf. Accessed 1 May 2011.
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Hyman, J.B., Leibowitz, A.B. (2013). Preoperative Assessment and Optimization. In: Levine, A., Govindaraj, S., DeMaria, Jr., S. (eds) Anesthesiology and Otolaryngology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4184-7_7
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