Practice Advisory for Preanesthesia Evaluation: An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation

Abstract

PRACTICE Advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories provide a synthesis and analysis of expert opinion, clinical feasibility data, open forum commentary, and consensus surveys. Practice Advisories developed by the American Society of Anesthesiologists (ASA) are not intended as standards, guidelines, or absolute requirements, and their use cannot guarantee any specific outcome. They may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies.Practice Advisories are not supported by scientific literature to the same degree as standards or guidelines because of the lack of sufficient numbers of adequately controlled studies. Practice Advisories are subject to periodic update or revision as warranted by the evolution of medical knowledge, technology, and practice.This document updates the “Practice Advisory for Preanesthesia Evaluation: A Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation,” adopted by the ASA in 2001 and published in 2002.*The literature does not provide a standard definition for preanesthesia evaluation. For this Practice Advisory, preanesthesia evaluation is defined as the process of clinical assessment that precedes the delivery of anesthesia care for surgery and for nonsurgical procedures. For this Advisory, “perioperative” refers to the care surrounding operations and procedures. The preanesthetic evaluation is the responsibility of the anesthesiologist.Preanesthesia evaluation consists of the consideration of information from multiple sources that may include the patient's medical records, interview, physical examination, and findings from medical tests and evaluations. As part of the preanesthesia evaluation process, the anesthesiologist may choose to consult with other healthcare professionals to obtain information or services that are relevant to perioperative anesthetic care. Preoperative tests, as a component of the preanesthesia evaluation, may be indicated for various purposes, including but not limited to (1) discovery or identification of a disease or disorder that may affect perioperative anesthetic care; (2) verification or assessment of an already known disease, disorder, medical or alternative therapy that may affect perioperative anesthetic care; and (3) formulation of specific plans and alternatives for perioperative anesthetic care.The assessments made in the process of preanesthetic evaluation may be used to educate the patient, organize resources for perioperative care, and formulate plans for intraoperative care, postoperative recovery, and perioperative pain management.The purposes of this Advisory are to (1) assess the currently available evidence pertaining to the healthcare benefits of preanesthesia evaluation, (2) offer a reference framework for the conduct of preanesthesia evaluation by anesthesiologists, and (3) stimulate research strategies that can assess the healthcare benefits of a preanesthesia evaluation.A preanesthesia evaluation is considered a basic element of anesthesia care. Therefore the focus of this Advisory is the assessment of evidence pertaining to the content and timing of a preanesthesia evaluation. The interactions between the preanesthesia evaluation, preoperative testing, and perioperative care are beyond the scope and mandate of the Advisory. Informed consent, often undertaken at the same time as the preanesthesia evaluation, is also beyond the scope of this Advisory.This Advisory is intended for use by anesthesiologists and those who provide care under the direction of an anesthesiologist. The Advisory applies to patients of all ages who are scheduled to receive general anesthesia, regional anesthesia, and moderate or deep sedation for elective surgical and nonsurgical procedures. The Advisory does not address the selection of anesthetic technique; nor does it address the preanesthetic evaluation of patients requiring urgent or emergency surgery or anesthetic management provided on an urgent basis in other locations, (e.g. , emergency rooms).Any evaluations, tests, and consultations required for a patient are done with the reasonable expectation that such activities will result in benefits that exceed the potential adverse effects. Potential benefits may include a change in the content or timing of anesthetic management or perioperative resource use that may improve the safety and effectiveness of anesthetic processes involved with perioperative care. Potential adverse effects may include interventions that result in injury, discomfort, inconvenience, delays, or costs that are not commensurate with the anticipated benefits.The original Advisory was developed by an ASA-appointed task force of 12 members, consisting of anesthesiologists from various geographic areas of the United States and two methodologists from the ASA Committee on S