Department of Anesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden.
Curr Opin Anaesthesiol. 2009 Dec;22(6):705-11. doi: 10.1097/ACO.0b013e3283301fb3.
With the rapid increase in the number of sicker patients with multiple co-morbidities and extremes of age who are undergoing ambulatory surgery, a thorough and detailed preoperative workup has become increasingly important. Case cancellation on the morning of surgery should be an exception. Therefore, much attention is focused on the optimization of the sicker patients. Although the anesthesiologist plays a central role in the preoperative assessment, a multidisciplinary approach is critical. This review was done to provide the reader with current trends and practices in preoperative assessment of the ambulatory surgical patient.
The risk factors that may influence major morbidity, death or hospital admission include age greater than 85 years, hospital admission within the previous 6 months and invasiveness of surgery. The American Society of Anesthesiologists' physical status greater than 2 can predict in-hospital adverse events. Routine preoperative investigations in the healthy patient, including electrocardiogram are, today, unwarranted and have not been shown to improve outcome.
Risk management involves the identification of the patient at risk, optimization of preoperative health status, risk reduction through medical intervention as well as appropriate perioperative care. Thus, patient outcome can be improved, specifically for the sicker patients at a higher risk.
随着越来越多患有多种合并症和年龄极端的需要接受门诊手术的病情较重的患者数量的增加，全面详细的术前检查变得越来越重要。手术当天早上取消手术应该是例外。因此，人们非常关注病情较重的患者的优化问题。尽管麻醉师在术前评估中起着核心作用，但多学科方法至关重要。本综述旨在为读者提供门诊手术患者术前评估的当前趋势和实践。
可能影响主要发病率、死亡或住院的危险因素包括年龄大于 85 岁、过去 6 个月内住院以及手术的侵袭性。美国麻醉医师协会的身体状况大于 2 可以预测院内不良事件。在健康患者中，包括心电图在内的常规术前检查如今是不必要的，并且没有显示出可以改善结果。
风险管理涉及识别风险患者、优化术前健康状况、通过医疗干预降低风险以及适当的围手术期护理。因此，可以改善患者的预后，特别是对于风险较高的病情较重的患者。
