Preoperative Interview

Without getting into great detail as this forum is merely just a brief introduction into what exactly CRNAs do on a daily basis, the preoperative phase of case is about determining whether or not it is safe for the patient to proceed with his/her scheduled surgery. In essence, there are a set of pre-determined questions that should be asked of all patients and again, for the purposes of this post, we’ll just keep the discussion relegated to these questions. There’s a lot of nuance involved with performing a preoperative evaluation, but ultimately, you want to make sure that the patient’s heart and lungs can withstand the stress of surgery.
Questions that are asked of every patient and why:
(1) What kind of surgery are you having done today?
Sounds silly, but it’s not. Wrong site, person, and/or surgical errors occur in about 1 out of 112,000 procedures performed in the US. While the statistics surrounding this topic are relatively low, the reality is it should be zero and the reason why it’s not is because the operating room environment is a fast paced, high stress environment. In my nascent career, I’ve noticed many individuals (from surgeons to anesthesia providers to nurses) develop tunnel vision with their workflow and because they’re so focused on completing the task at hand, sometimes they forget what it is exactly we’re doing, which is providing patient centered care. So, I ask every one of my patients to describe in their own words what is going to be done to them.
(2) Do you have any allergies? 
Some patients may have allergies to certain medications you will provide in the operating room, so being notified of this will alert me to avoid using such a medication and to determine whether another medication can be used as a substitution. For example, if a patient says he or she is allergic to an antibiotic that is commonly administered in the operating room, then obviously it makes sense to avoid the medication altogether and to find one that is more suitable for the patient.
(3) Have you or anyone in your family ever had complications to anesthesia?
Obviously any type of self-reported complications should be taken seriously as there are certain conditions that predispose patients to serious, if not deadly, harm if they are exposed to certain anesthetics, like anesthesia gases. Most of the time, patients say no. Sometimes patients will complain of nausea and vomiting after receiving anesthesia, which is actually pretty common because being exposed to anesthesia gas and receiving pain medication predisposes an individual to experiencing nausea when they wake up. Some individuals are more susceptible than others. Again, without getting too complicated in this discussion, we often administer a cocktail of anti nausea medications to help combat this.
(4) When was the last time you had something to eat or drink?
We often tell patients to not eat or drink anything by midnight on the day of their surgery because we essentially want your stomach to be empty. Having any type of food or drink in your stomach prior to surgery places you at a risk for aspiration (vomiting and inhaling gastric contents), so we try to minimize that by telling patients to not consume anything for several hours before surgery.
(5) Have you had any recent chest pain, dizziness, or shortness of breath?
Any symptoms that have not been identified and treated by the patient’s physician should alert an anesthesia provider that further workup is needed before proceeding with surgery. Taking a patient into surgery with active symptoms that has not been appropriately addressed places that patient at risk for an untoward event (such as a myocardial infarction, ischemic stroke, etc.).
(6) Can you walk up a flight or several flights of stairs without experiencing chest pain, dizziness, or shortness of breath?
Semi-related to the previous question, anesthesia providers are interested in assessing a patient’s functional capacity (i.e., an individual’s ability to perform certain tasks). Simply put, can a patient perform certain activities without having symptoms? Surgery stresses the body, so when I ask a patient to describe his/her ability to climb a set of stairs, I’m basically trying to ascertain if they can handle the stress of surgery.
(7) Last, but not least, is obtaining consent. Basically, this portion of the interview involves a discussion regarding the risks and benefits of the anesthetic you and your patient decide upon. In anesthesia, we can either provide (1) monitored anesthesia care (i.e., IV sedation), (2) regional anesthesia (i.e., performing nerve blocks), and/or (3) general anesthesia (i.e., the part of anesthesia everyone is familiar with; completely under anesthesia and intubated with an endotracheal tube). I generally like to have an in-depth discussion about what I have planned for my patients and I try to set realistic goals for them so that they can mentally prepare themselves for what happens after surgery.
In a nutshell, that’s what the preoperative interview consists of. There’s more to it than this, but the crux of the interview is to determine what kind of risk the patient poses if he/she were to have surgery.
Advertisements