Recent guidelines in preoperative assessment, premedication&perioperative documentation

Document Type : Original Article


1 Department, of Anesthesia and intensive care, Fuclty of Medicine, Sohag University.

2 Department of Anesthesia, Faculty of Medicine,Sohag University.

3 Department of Anesthesia, Faculty of Medicine, Sohag University.


Introduction: The corner stone of an effective preoperative evaluation are the history and physical examination, which should include a complete account of all medications taken by the patient in the recent past, and responses and reactions to previous anesthetics.Premedication is the administration of medication before anesthesia. Premedication is used to prepare the patient for anesthesia and to help provide optimal conditions for surgery. The anesthetic record is usually the sole documentation of an anesthetist’s interaction with his or her patient.
Aim of the work: This work aims to review the recent guidelines in preoperative assessment, premedication and perioperative documentation to reach a conclusion and a protocol of management that can be applicable in our hospital.
Materials and methods: This is a clinical review of recent guidelines in preoperative assessment ,premedication ,perioperative documentation based on explore other protocols and researches.
The strategy followed in doing this review is as follow; Exploring the data allowed for the recent guidelines in preoperative assessment, premedication, perioperative documentation
1-Sites to be visited.
2-Recent searches in the last 5 years.
3-Search terms including preoperative assessment, patient preparation ,premedication ,perioperative documentation, anesthetic record .
4-Bibliographies of articles are also searched for relevant articles.
5-English language studies and full text studies will be preferred.
Conclusion: The goals of the preanesthesia evaluation are twofold: first, to ensure that patients can safely tolerate anesthesia for planned surgical procedures; and second, to mitigate risks associated with the overall perioperative period, such as postoperative pulmonary or cardiac complications. The patient’s comorbidities and planned procedure must be considered when managing medications in the perioperative period.
     Accurate and thorough documentation is an essential element of high quality and safe medical care, and accordingly a basic responsibility of physician anesthesiologists.


  1. Morgan & Mikhail's Clinical Anesthesiology, 5e chapter 18.
  2. Cleveland Clinic journal ofmedicine  2004.
  3. Oxford Textbook of Surgery4th Edition 2004.
  4. MerchantR, Bosenberg C, Brown K, Chartrand D, Dain S, Dobson J, et al. Guidelines on the practice of anaesthesia Revised 2010. Can J Anaesth. 2010;57:58–87.
  5. PolanczykCA, Marcantonio E, Goldman L, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med; 134:637–643 2001.
  6. SelzmanCH, Miller SA, Zimmerman MA, et al. The case for betaadrenergic blockade as prophylaxis against perioperative cardiovascular morbidity and mortality. Arch Surg; 136:286–290 2001 .
  7. Aykut,K., Albayrak, G., Guzeloglu, M., Baysak, A., & Hazan, E.. Preoperative mild cognitive dysfunction predicts pulmonary complications after coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia,1267-1270.Retrieved March12,2015,from /pii/S105307701 3000360#.(2013
  8. Coulter A, Collins A. Making shared decision-making a reality: no decision about me, without me. The King’s Fund, London  ( 2011.
  9. Fleisher LA, Beckman JA, Brown KA, et al: ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/ AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, Circulation, 120:e169-e276, 2009.
  10. Wijeysundera DN, Austin PC, Beattie WS, et al: Variation in the practice of preoperative medical consultation for major elective noncardiac surgery: a population-based study, Anesthesiology, 116:25-34, 2012.
  11. Sharma G, Kuo YF, Freeman J, et al: Comanagement of hospitalized surgical patients by medicine physicians in the United States, Arch Intern, , Med 170:363-368 2010 .
  12. Goldman, L., Caldera, D., Nussbaum, S., Southwick, F., Krogstad, D., Murray, B., Slater, E. (1977). Multifactorial index of cardiac risk in noncardiac surgical procedures. New England Journal of Medicine, 297(16), 845-850. Retrieved February 28, from, 2015.
  13. Lee, T., Marcantonio, E., Mangione, C., Thomas, E., Polanczyk, C., Cook, E., . . . Goldman, L. (1999). Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 100(10), 1043-1049. Retrieved February 28, , 2015
  14. Mazo, V., Sabaté, S., Canet, J., Gallart, L., Gama de Abreu, M., Belda, J., Pelosi, P. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology, (2014).V 121(2), 219-231. Retrieved January 13, 2015.
  15. Kim, S., Brooks, A., Groban, L. (2015). Preoperative assessment of the older surgical patient: Honing in on geriatric syndromes. Clinical Interventions in Aging, 10, 13-27. Retrieved February 17, from, 2015.
  16. Hulzebos EH, Helders PJ, Favie NJ, De Bie RA, Brutel de la Riviere A, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. Oct 18. 296(15):1851-7 2006  .
  17. Wu CC, Yeh DC, Lin MC, Liu TJ, P’Eng FK. Improving operative safety for cirrhotic liver resection. Br J Surg. 2001 Feb;88(2):210-5.
  18. Befeler AS, Palmer DE, Hoffman M, et al: The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome, Arch Surg 140:650-654, , discussion, p 655. 2005
  19. Pearse RM, Moreno RP, Bauer P, et al: Mortality after surgery in Europe: a 7 day cohort study, Lancet, 380:1059-1065, 2012.
  20. Rosenman DJ, McDonald FS, Ebbert JO, et al: Clinical consequences of withholding versus administering renin-angiotensinaldosterone system antagonists in the preoperative period, J Hosp Med, 3:319-325, 2008.
  21. Kheterpal S, Khodaparast O, Shanks A, et al: Chronic angiotensinconverting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery, J Cardiothorac Vasc Anesth, 22:180-186, 2008 .
  22. Khan NA, Campbell NR, Frost SD, et al: Risk of intraoperative hypotension with loop diuretics: a randomized controlled trial, Am J Med, 123:1059.e1-e8, 2010 .
  23. Horlocker TT, Wedel DJ, Rowlingson JC, et al: Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence- based guidelines (third edition), Reg Anesth Pain Med, 35: 64-101, 2010.
  24. Grady D, Wenger NK, Herrington D, et al: Postmenopausal hormone therapy increases risk for venous thromboembolic disease: the Heart and Estrogen/progestin Replacement Study, Ann Intern Med, 132:689-696,2000.
  25. QMDA approved by ASA 2015 .
  26. Swart M, Houghton K. Pre-operative preparation: essential elements for delivering enhanced recovery pathways. Curr Anaesth Crit Care;21:142–147 2010.
  27. Mutcherson KM: Whose body is it anyway? An updated model of healthcare decision-making rights for adolescents, Cornell J Law Public Policy, 2005, 14(25):251-325.
  28. SimpsonJC et al. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth;115:560–568 2015 .
  29. Davies JM: Consent in laboring patients. In Van Norman G, Jackson S, Rosenbaum S, Palmer S, editors: Clinical ethics in anesthesiology: a case-based textbook. Cambridge, , Cambridge University Press, pp 44-48, 2011..
  30. McCombe K, Bogod DG. Paternalism and consent: has the law finally caught up with the profession? Anaesthesia;70:1016–1019  2015 .
  31. azirani S, Lankarani-Fard A, Liang L-J, et al: Perioperative processes and outcomes after implementation of a hospitalist-run preoperative clinic, J Hosp Med, 7:697-701, 2012.
  32. Public Hospitals Act, Revised Statutes of Ontario, 1990.
  33. QMDA approved by ASA 2015.