The perioperative period is emotionally stressful for patients who frequently have fears about surgery, anesthesia, diagnoses, complications, and mortality. The anesthesiologist can alleviate much of this stress with a thoughtful discussion. Moreover, the anesthesiologist should explain the events of the perioperative period and give instruction and information on the following:

Perioperative procedures

Perioperative procedures. Explanation of the procedures that will occur prior to induction—placement of intravenous, arterial, or epidural catheters, placement of routine monitors, preoxygenation, cricoid pressure—­with reassurance that supplemental sedation and analgesia will be provided as necessary.

Perioperative medication use

Perioperative medication use. If a necessary medication was forgotten on the morning of surgery, it should be given by the anesthesiologist. Preoperative oral medications, such as acetaminophen, gabapentin, and celebrex, are commonly seen in patients getting multimodal pain control (see Section VI).

Preoperative fasting

Preoperative fasting. Specific instructions about fasting should be addressed. See Table 1.2.

Postoperative recovery

Postoperative recovery. Explain the intended plan for postoperative recovery in the postanesthesia care unit or ICU.

Pain control

Pain control. Detail the plan for perioperative pain control.

Autologous blood donation

Autologous blood donation. Autologous donation may be considered in the stable patient scheduled for surgery in which blood transfusion is likely.

Tables

Outline

• Introduction
• History
• Review of Systems
• The Physical Examination
• Laboratory Studies
• Preoperative Medical Optimization
• Anesthetic Assessment and Plan
• Patient Discussion
• Informed Consent
• Day of Surgery Premedication
• Delaying Surgical Procedures
• Ethical Considerations in Patient Care
• Suggested Readings