Practice advisory for preanesthesia evaluation: A report by the American Society of Anesthesiologists Task Force on preanesthesia evaluation

A preanesthesia evaluation involves the assessment of information from multiple sources, including medical records, patient interviews, physical examinations, and findings from preoperative tests. The current scientific literature does not contain sufficiently rigorous information about the components of a preanesthesia evaluation to permit recommendations that are unambiguously based. Therefore, the Task Force has relied primarily upon noncontrolled literature, opinion surveys of consultants, and opinion surveys of a random sample of members of the ASA. The focus of opinion surveys has been threefold (1) the content of the preanesthesia evaluation, (2) the timing of the preoperative evaluation, and (3) the indications for specific preoperative tests. The following remarks represent a synthesis of the opinion surveys, literature and Task Force consensus: 1. Content of the preanesthesia evaluation includes but is not limited to (1) readily accessible medical records, (2) patient interview, (3) a directed preanesthesia examination, (4) preoperative tests when indicated, and (5) other consultations when appropriate. At a minimum, a directed preanesthesia physical examination should include an assessment of the airway, lungs, and heart. 2. Timing of the preanesthesia evaluation can be guided by considering combinations of surgical invasiveness and severity of disease, as shown in table 2. The Task Force cautions that limitations in resources available to a specific healthcare system or practice environment may impact the timing of the preanesthesia evaluation. The healthcare system is obligated to provide pertinent information to the anesthesiologist for the appropriate assessment of the invasiveness of the proposed surgical procedure and the severity of the patient's medical condition well in advance of the anticipated day of procedure for all elective patients. 3. Routine preoperative tests (i.e., tests intended to discover a disease or disorder in an asymptomatic patient) do not make an important contribution to the process of perioperative assessment and management of the patient by the anesthesiologist. 4. Selective preoperative tests (i.e., tests ordered after consideration of specific information obtained from sources such as medical records, patient interview, physical examination, and the type or invasiveness of the planned procedure and anesthesia) may assist the anesthesiologist in making decisions about the process of perioperative assessment and management. 5. Decision-making parameters for specific preoperative tests or for the timing of preoperative tests cannot be unequivocally determined from the available scientific literature. Further research is needed, preferably in the form of appropriately randomized clinical trials. Specific tests and their timing should be individualized and based upon information obtained from sources such as the patient's medical record, patient interview, physical examination, and the type and invasiveness of the planned procedure.