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Table of Contents
LETTER TO EDITOR  
Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 77-78
Preanesthesia assessment clinic for cardiac surgery by cardiac anesthesiologist: A practice statement


1 Department of Cardiac Anesthesia, Durdans Heart Surgical Centre, Alfred Place, Colombo 03, Sri Lanka
2 Department of Cardiac Surgery, Durdans Heart Surgical Centre, Alfred Place, Colombo 03, Sri Lanka

Click here for correspondence address and email

Date of Web Publication2-Jan-2014
 

How to cite this article:
Malik M, Panchal AM, Dev KK. Preanesthesia assessment clinic for cardiac surgery by cardiac anesthesiologist: A practice statement. Ann Card Anaesth 2014;17:77-8

How to cite this URL:
Malik M, Panchal AM, Dev KK. Preanesthesia assessment clinic for cardiac surgery by cardiac anesthesiologist: A practice statement. Ann Card Anaesth [serial online] 2014 [cited 2019 Oct 19];17:77-8. Available from: http://www.annals.in/text.asp?2014/17/1/77/124167


The Editor,

Preanesthesia assessment clinics (PAC's) have been in existence for quite a long time in general surgical practice and have contributed a lot in terms of reducing patient anxiety and fear, improving the quality of pre operative care and cutting pre operative costs. [1] However, PAC's have not yet taken shape in cardiac surgical practice in most of the teaching hospitals as well as private hospitals. Even though the major cause of cancellation on the day of surgery has been found to be inadequate medical checkup, [2],[3],[4] there has not been much stress on setting up PAC's for cardiac surgical patients.


   Current Practice at Most Hospitals Top


0Cardiologist refers the patient for surgery to the cardiac surgeon who in turn accepts and schedules the patient for surgery. Cardiac anesthesiologist interacts with the patient only a day prior to surgery and mostly after admission in hospital. A lot of precious time is available in this intervening period (from referral to cardiac surgeon until the time patient is admitted for proposed surgery), which we utilize for preanesthetic assessment.


   Practice at the Author's Hospital Top


0Author's hospital is a tertiary care center performing about 700-800 cardiac surgeries annually. At our hospital, patients are accepted by the cardiac surgeon for surgery and thereafter begin the process of preanesthetic assessment, risk stratification and scheduling the patient for surgery as follows:

Step I

First patient visit: Cardiac surgeon refers the patient to cardiac anesthesiologist who reviews the medical history, general examination notes, available investigations and examines the patient; thereafter, directs the supporting staff to schedule the patient for surgery according to waiting list.

Step II

Second patient visit: 10 days prior to provisional date of surgery; patient is asked to undergo pre-operative investigations as per the hospital's protocol.

Step III

Seven days prior to surgery: Investigation results are reviewed by the anesthesiologist and any consultations (nephrology, neurology etc.) if required are informed telephonically to the patient. If the patient is declared fit for anesthesia and surgery, risk stratification is done according to European system for cardiac operative risk evaluation 2 (EuroSCORE 2) and Society of Thoracic Surgeons (STS) risk scoring system and patient is informed about the risk telephonically. At the same time, a final and confirmed date for surgery is given to patient. Patient is also advised about drug treatment and stoppage of certain drugs like clopidogrel, warfarin as per the hospital's protocol.

Step IV

Third visit (Optional) for patients who require consultations: A review of such patients' records is made after every 2 days and the patient is informed about the progress. If the patient insists on a visit, the patient is called and is explained in detail about the further procedure and the approximate time required to enable him to undergo surgery.

The patients found fit after step III are admitted only 1 day prior to surgery and a review of preanesthetic assessment is performed. If a patient is scheduled as 2 nd /3 rd case in the day, he/she is given the option of admission on the day of surgery. All instructions regarding fasting requirements, drug treatment are given to patient telephonically if he/she opts for admission on the day of surgery.

We have been following the above protocol and compared the cancellation rates on the day of surgery in the corresponding period in the previous year and the current year and found zero cancellations on the day of surgery [Table 1].

In addition, the PAC protocol has benefitted in other terms also such as:

  1. No unnecessary patient admissions and delays
  2. All patients being worked up for surgery on an out-patient basis
  3. Better organization of operating room (OR) schedules. The OR schedules are almost always ready for the next 5-7 days
  4. Better rapport between patient and anesthesiologist specially regarding pain relief
  5. Better coordination between operating teams in combined procedures such as coronary artery bypass grafting (CABG) and thyroidectomy, CABG and cholecystectomy
  6. Risk stratified informed consent and cost: Patients are categorized as low, moderate, or high risk according to EuroSCORE 2 and are billed accordingly.


The whole process requires a team of anesthesiologist, supporting staff (for scheduling the patient, tracking investigation results, informing patients) and support from the surgeon. For high volume centers, a team of anesthesiologist can be posted on a rotational basis in PAC's. However, at such centers, fixed protocols for preanesthetic assessment have to be in place as there might be differences of opinion between anesthesiologist performing preanesthetic assessment and the anesthesiologist who will actually administer anesthesia.

 
   References Top

1.Gupta A, Gupta N. Setting up and functioning of a preanaesthetic clinic. Indian J Anaesth 2010;54:504-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Farasatkish R, Aghdaii N, Azarfarin R, Yazdanian F. Can preoperative anesthesia consultation clinic help to reduce operating room cancellation rate of cardiac surgery on the day of surgery? Middle East J Anesthesiol 2009;20:93-6.  Back to cited text no. 2
[PUBMED]    
3.Conway JB, Goldberg J, Chung F. Preadmission anaesthesia consultation clinic. Can J Anaesth 1992;39:1051-7.  Back to cited text no. 3
[PUBMED]    
4.Badner NH, Craen RA, Paul TL, Doyle JA. Anaesthesia preadmission assessment: A new approach through use of a screening questionnaire. Can J Anaesth 1998;45:87-92.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
Madhur Malik
Durdans Heart Surgical Centre, Alfred Place, Colombo 03
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124167

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