Preoperative Evaluations in Cosmetic Treatment

The time and energy devoted to the preoperative preparation of the surgical patient should be com mensurate to the efforts expended on the evaluation and preparation for anesthesia. The temptation to leave preoperative anesthesia preparation of the patient as an afterthought must be resisted. Even if an anesthesiologist or a CRNA is to be involved later,the surgeon bears responsibility for the initial evaluation and preparation of the patient. Thorough pre operative evaluation and preparation by the surgeon increases the patients confidence, reduces costly and inconvenient last-minute delays, and reduces overall perioperative risk to the patient.If possible, the preoperative evaluation should be performed with the assistance of a spouse, parent, or significant other so that elements of the health history or recent symp toms may be more readily recalled. A comprehensive preoperative evaluation form is a useful tool to begin the initial assessment. Informa tion contained in the history alone may determine the diagnosis of the medical condition in nearly 90% of patients.While a variety of forms are available in the literature, a check-list format to facilitate the patient’s recall is probably the most effective. Regardless of which format is selected, information regarding all prior medical conditions, prior surgeries and types of anesthetics, current and prior medi cations, adverse outcomes to previous anesthetics or other medications, eating disorders, prior use of anti obesity medication, and use of dietary supplements, which could contain ephedra, should be disclosed bythe patient.A family history of unexpected or early health conditions such as heart disease, or unexpected reactions, such as malignant hyperthermia, to anesthet ics or other medications should not be overlooked. Finally, a complete review of systems is vital to iden tifying undiagnosed, untreated, or unstable medical conditions that could increase the risk of surgery or anesthesia. Last-minute revelations of previously undisclosed symptoms, such as chest pain, should be avoided. Indiscriminately ordered or routinely obtained preoperative laboratory testing is now considered to have limited value in the perioperative prediction of morbidity and mortality. In fact, one study showed no difference in morbidity in healthy patientswithout preoperative screening tests versus morbid ity in a control group with the standard preoperative tests. Multiple investigations have confirmed that the preoperative history and physical examination is superior to laboratory analysis in determining the clinical course of surgery and anesthesia.Newer guidelines for the judicious use of laboratory screening are now widely accepted.Additional preoperative tests may be indicated for patients with prior medical conditions or risk factors for anesthesia and surgery. Consultation from other medical specialists should be obtained for patients with complicated or unstable medical conditions. Patients with ASA III risk designation should be referred to the appropriate medical specialist prior to elective surgery. The consultant’s role is to determine if the patient has received optimal treatment and if the medical condition is stable. Additional preoperative testing may be considered necessary by the consultant. The medical consultant should also assist with stabilization of the medical condition in the perioperative period if indicated. If the surgeon has concerns about a patient’s ability to tolerate anesthesia, a telephone discussion with an anesthesiologist or even a formal preoperative anesthesia consultation may be indicated. Certain risk factors, such as previously undiagnosed hypertension, cardiac arrhythmias, and bronchial asthma, may be identified by a careful physical examination. Preliminary assessment of head and neck anatomy to predict possible challenges in the event endotracheal intubation is required may serve as an early warning to the anesthesiologist or CRNA even if a general anesthetic is not planned. For most ambulatory surgeries, the anesthesiologist or CRNA evaluates the patient on the morning of surgery. Medical hints on how to cure inesthethisms are explained chirurgia estetica

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