Pre-operative assessment

This is your time to meet with an anesthetist and ask all the questions about your anesthesia.

This is our time to meet you and if needed take steps to make sure you are in the best possible health. We also try to answer as many questions as we can about your anesthetic. Research has shown that this visit can go a far way to reduce your anxiety about your surgery.

The outpatient clinic used for interviewing you before your surgery is called the pre-assessment clinic (or ‘PAC’ for short). This encounter may also take place in the out-patient clinic sometime prior to surgery; in the hospital if you are already admitted, or in the operating area on the day of surgery prior to going into the operating room. Sometimes, it may take place in a telephone interview.


The visit to the pre-assessment clinic involves a few steps.

Nursing staff plays a very important role in gathering information, answering your questions and giving you more information about your surgery and recovery.

Firstly, the anesthetist gather all the relevant information - which may include:
 

  1. Your previous operations and anesthetic experiences
  2. Any difficulties you have had with past anesthetics
  3. Any serious complications of anesthesia experienced by you or your family members (such as malignant hyperthermia)
  4. Any allergies you have (or drug sensitivities)
  5. Whether you have any chronic medical conditions.
  6. What medications you are taking, including prescription medications, over the counter medications, and herbal preparations.
  7. If you are a woman, whether you are or could be pregnant, or whether you are currently breast feeding
  8. If you are hearing, vision or mobility impaired, or require any other special assistance
  9. If you are able to speak and understand English, or may require a translator.

The anesthetist may ask for permission to obtain medical records from your primary care physician or other healthcare givers as a part of your preoperative evaluation. Whenever possible, you should plan to bring any medical records you have with you to your evaluation. In addition, bring a complete medication list with dosages. Alternatively, you could bring all of your medications with you on the day of your interview.

This is followed by a brief physical examination.

A decision is now made regarding the need for further tests - some of these are always done if your are a certain age, gender or a specific surgery (we call these ‘routine’ tests). Your anesthetist or surgeon may request additional tests depending on the information gathered earlier.

After you have been deemed ‘fit for OR’ (meaning the anesthetist is happy to proceed without needing more information or testing) - we talk to you about the what we plan for your upcoming surgery which may include:

  • when to stop eating or drinking before surgery
  • which medications to take or not take prior to surgery
  • the options for anesthesia (ie. general anesthetic, regional anesthesia, sedation, or a combination of these.)
  • special measures that may be taken in your case (ie. extra monitors, need for stay in intensive care after surgery, etc.)
  • the risk of anesthesia in your case given the type of surgery and any other medical conditions you may have (such as heart or lung disease)
  • the options for pain management after the surgery (ie. patient controlled analgesia [IV “pain pumps”] or an epidural or a nerve block

In most hospitals the anesthetist you talk to during the preoperative encounter, is unlikely to be the anesthetist that will be responsible for your care on the day of your surgery. On the day of surgery, the anesthetist responsible for your care will finalize the ‘anesthetic plan’. This is based on your health profile, the surgery you are having.

While we try to accommodate your preference for a specific anesthetic technique (for example a general anesthetic vs. regional anesthetic) as far as we can, we do have the expertise to know what is the best option in your case. Discussing the benefits and risks of certain anesthetic techniques is part of the informed consent process.
 


Written by:
Dr. Katherine Marseu MD (Resident Anesthetist) 
Dr. Martin van der Vyver MBChB FRCPC (Specialist Anesthetist)

Reviewed by:
Dr. Lesley Sinclair MD FRCPC (Specialist Anesthetist)

Date created: November 8, 2010