Preop Clinic:

Your Preoperative Visit with an Anesthesiologist

Optimizing Your Care

The anesthesiologist is the perioperative physician who provides medical care to patients throughout their surgical experience. This spectrum of care includes the medical evaluation of patients before surgery, consulting with the surgical team and providing pain support and control of life functions during surgery, supervising care after surgery, and medically discharging a patient from a recovery unit. In addition, anesthesiologists provide sedation and anesthesia for patients undergoing medical and dental procedures, as well as care for patients during their obstetrical experience.

The rationale for visiting the preoperative anesthesia clinic is to insure that your overall medical condition is the best it can be prior to encountering the stresses of anesthesia and surgery. Given the position the anesthesiologist occupies as a perioperative physician, this person is uniquely qualified to assess, from a medical standpoint, your fitness to undergo anesthesia and surgery. In addition, some patients have special questions and concerns that are best addressed by an anesthesiologist. At the time that you undergo a history and physical exam in the surgery clinic, your surgical team will determine whether a visit to the preoperative anesthesia clinic is warranted.

Co-existing Conditions

The most common problems that need further medical evaluation in surgical patients are cardiac (heart) and pulmonary (lung) diseases. Specifically, coronary artery disease (blocked blood vessels on the heart), asthma, and emphysema (COPD) are medical conditions that most often require further testing or treatment prior to elective surgery. Surgery and anesthesia can be very stressful and, coupled with the above diseases, can lead to adverse outcomes (example: heart attack after surgery) that can threaten patients’ well being, or even their lives. Obviously, a variety of patients with many different diseases still need and receive operations. Thus, a major goal of the perioperative physician is to diagnose and treat any coexisting medical conditions, so as to minimize the risk of the aforementioned adverse outcomes.

Further Testing and Evaluation May Be Ordered

Other diseases that may lead to adverse events if not well-controlled at the time of surgery include, diseases of the liver, kidneys, nervous system, musculoskeletal system, endocrine system (example: diabetes, thyroid disease) and hematological (blood) system. Based on the information obtained by the physician in the pre-op anesthesia clinic, you may need to undergo further testing, consultation, or therapy (medications, angioplasty, etc.) in order to minimize your risk when undergoing your procedure. Blood samples may need to be taken or x-rays performed in order to further clarify a given medical condition. Sometimes, special tests need to be ordered to determine the function of your heart, lungs, or some other organ system. You may also be referred to various medical specialists for diagnosis and treatment, if your medical condition warrants this. If your surgery is elective and you have an unstable medical condition, surgery may be delayed, so that your condition can be better evaluated and treated.

Airway Examination

You will undergo a brief physical exam by the physician in the Preop Clinic with special emphasis on aspects of your health that are pertinent to the administration of anesthesia. One area of particular concern to anesthesiologists is examination of the airway (mouth, throat, voice box and windpipe). Often, the anesthesiologist must breathe for the anesthetized patient, and must have a means of delivering oxygen and anesthetic gases into the airway. It is crucial that we recognize any abnormalities of the airway early so that we may make plans for management during your operation.

The Anesthetic Plan

Finally, your anesthesiologist will formulate an anesthetic plan for the surgery that you are to undergo. This plan will take into account your surgical procedure, any medical conditions you have, and your history of previous anesthetics combined with your particular likes and dislikes. Your anesthesiologist will discuss this plan with you during your visit, and will answer your questions. Often, the physician who evaluates you in the clinic will not be the one who delivers your anesthetic on the day of surgery. In all cases, however, a complete pre-anesthetic record will be forwarded to your actual anesthesiologist well in advance of your surgery date. Because different anesthesiologists have differing preferences in their practice, there is often more than one way to successfully provide for your comfort and safety during your operation. Hence, the physician who sees you in the clinic may discuss more than one anesthetic technique and the final decision will be left to the physician who delivers the anesthetic, in consultation with you. In most cases, your visit to the Preoperative Anesthesia Clinic will be your last stop of the day and, as you leave, your medical record will stay in the hands of the personnel in the clinic. Occasionally, you may be required to undergo some testing (blood draws, x-rays) after you leave the clinic.

Dept. of Anesthesiology, Univ. of Michigan Medical School

Copyright © 2004, Regents of the University of Michigan