The perioperative period is emotionally stressful for the patient who may have fears about surgery and anesthesia. The anesthesiologist can alleviate many of these fears by way of a thorough discussion with the patient. If the provider performing the assessment will not be the anesthetizing provider, the patient should be reassured that his or her concerns and needs will be relayed and addressed. Moreover, the anesthesiologist should explain, in detail, the events of the perioperative period. It would behoove the anesthesiologist to give instruction and information on the following:

Perioperative Procedures

Explanation of the procedures that will occur prior to induction (e.g., placement of intravenous, arterial or epidural catheters, placement of routine monitors, preoxygenation, cricoid pressure) with reassurance that supplemental sedation and analgesia (local and intravenous) will be provided as necessary during this period.

Perioperative Medication Use

Maintenance or discontinuation of medications in the perioperative period should be thoroughly explained to the patient.

Preoperative Fasting

See Table 1.1.

Postoperative Recovery

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

Pain Control

Detail the plan for perioperative pain control.

Autologous Blood Donation

Autologous donation may be considered in the stable patient scheduled for surgery in which blood transfusion is likely, such as total joint arthroplasty and radical prostatectomy. This donation can be arranged through the American Red Cross if in-house resources do not support it.

Tables

ASA Guidelines for Preoperative NPO Status (Table 1.1)

Outline

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