Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000200005
Brazilian Journal of Anesthesiology
Scientific Article

Implantação do Serviço de Avaliação Pré-Anestésica em Hospital Universitário: dificuldades e resultados

Implementation of a Preanesthetic Evaluation Service in a University Hospital: difficulties and results

Flora Margarida Barra Bisinotto; Maurício Pedrini Júnior; Alírio Alex Rosa Alves; Maria Abadia Pereira Roso Andrade

http://dx.doi.org/10.1590/S0034-70942007000200005 Braz J Anesthesiol, vol.57, n2, p.167-176, 2007
PDF Português
PDF English
Downloads: 0
Views: 913

Resumo

JUSTIFICATIVA E OBJETIVOS: A avaliação pré-operatória é a chave principal para um bom preparo pré-operatório e manuseio intra-operatório. Quando realizada em nível ambulatorial permite uma análise melhor, possibilitando investigações adicionais, melhorando a qualidade do preparo e diminuindo os custos hospitalares. O objetivo deste estudo foi analisar a implantação e o desenvolvimento do Serviço de Avaliação Pré-Anestésica (SAPAN) em Hospital Universitário, verificando quais foram as dificuldades e os resultados positivos encontrados. MÉTODO: Foram avaliados os dados relativos aos pacientes atendidos no ambulatório do SAPAN, pelos médicos em especialização com supervisão de um docente, nos primeiros nove meses de instalação. A consulta era feita seguindo uma ficha padronizada. Ao término, os pacientes eram liberados para o procedimento cirúrgico ou encaminhados para consulta com outros especialistas para controle de doenças específicas. Analisou-se o número de pacientes avaliados e o número de procedimentos cirúrgicos eletivos realizados nesse período e as diversas especialidades cirúrgicas, porcentagem de pacientes com intervenção cirúrgica suspensa por necessidade de controle de doenças, e as especialidades clínicas mais solicitadas. RESULTADOS: Realizaram-se 913 consultas ambulatoriais e 5.409 intervenções cirúrgicas eletivas. Várias clínicas não encaminharam seus pacientes para a avaliação. Por necessidade clínica, 11,9% dos pacientes tiveram o procedimento cirúrgico suspenso, e as clínicas envolvidas foram cardiologia (43,08%), pneumologia (25,74%), hematologia (21,65%) e endocrinologia (9,52%). CONCLUSÕES: Embora grande parte dos pacientes não tenha sido encaminhada pelas especialidades cirúrgicas, os dados iniciais do SAPAN permitiram demonstrar os benefícios de um serviço de preparo ambulatorial dos pacientes.

Palavras-chave

AVALIAÇÃO PRÉ-ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: Preoperative evaluation is the key for a good preoperative preparation and intraoperative handling. When done in the outpatient clinic, it allows for better analysis and further investigation, improving the quality of the preparation and decreasing hospital costs. The aim of this study was to analyze the implementation of the Serviço de Avaliação Pré-Anestésica (SAPAN Preanesthetic - Service) in a University Hospital, and to determine the difficulties and positive results. METHODS: The data regarding patients seen at the SAPAN clinic, by the residents, under the supervision of an attending physician, in the first nine months after its implementation was reviewed. The consultation followed a standard form. At the end of the preanesthetic evaluation, patients were either cleared for surgery or referred to other specialties for the treatment of specific diseases. The items analyzed were: number of patients evaluated, number of elective surgeries performed during this period, surgical specialties involved, percentage of patients whose surgeries were cancelled due to the need to control underlying diseases, and clinical specialties requested the most to evaluate and treat those patients. RESULTS: Nine hundred and thirteen outpatient consultations and 5,409 elective surgeries were performed. In 11.9% of the cases, the surgeries were cancelled for medical reasons, and the most frequent specialties involved were cardiology (43.08%), pneumology (25.74%), hematology (21.65%), and endocrinology (9.52%). CONCLUSIONS: Although the majority of patients was not referred by the surgical specialties, the initial SAPAN data demonstrated the benefits of a preanesthetic evaluation service.

Keywords

PREANESTHETIC EVALUATION

References

Greer AE, Irwin MG. Implementation and evaluation of guidelines for preoperative testing in a tertiary hospital. Anaesth Intensive Care. 2002;30:326-330.

Charpak Y, Blery C, Chastang C. Prospective assessment of a protocol for selective ordering of preoperative chest x-rays. Can J Anaesth. 1988;35:259-264.

Fowkes FG, Davies ER, Evans KT. Multicentre trial of four strategies to reduce use of a radiological test. Lancet. 1986;1:367-370.

Pasternak LR. ASA practice guidelines for preanesthetic assessment. Int Anesthesiol Clin. 2002;40:31-46.

Davies JM, Pagenkopf D, Todd K. Comparison of selection of preoperative laboratory tests: the computer vs the anaesthetist. Can J Anaesth. 1994;41:1156-1160.

Nascimento Jr P, Kirsch LA, Samaha JT. Avaliação da necessidade da dosagem rotineira de hematócrito, hemoglobina, uréia e creatinina séricos durante a avaliação pré-anestésica. Rev Bras Anestesiol. 1998;48:264-271.

Olson RP, Stone A, Lubarsky D. The prevalence and significance of low preoperative hemoglobin in ASA 1 or 2 outpatient surgery candidates. Anesth Analg. 2005;101:1337-1340.

Bryson GL. Has preoperative testing become a habit?. Can J Anaesth. 2005;52:557-561.

Halaszynski TM, Juda R, Silverman DG. Optimizing postoperative outcomes with efficient preoperative assessment and management. Crit Care Med. 2004;32:76-S86.

Lee JA. The anesthetic outpatient clinic. Anaesthesia. 1949;4:169-174.

Eagle K, Berger P, Calkins H. ACC/AHA Guideline update for perioperative cardiovascular evaluation for noncardiac surgery - executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2002;39:542-553.

Gusman PB, Nascimento Jr P, Castiglia YMM. Avaliação pré-anestésica ambulatorial. Rev Bras Anestesiol. 1997;47:522-527.

Kaplan EB, Sheiner LB, Boeckmann AJ. The usefulness of preoperative laboratory screening. JAMA. 1985;253:3576-3581.

Foss JF, Apfelbaum J. Economics of preoperative evaluation clinics. Curr Opin Anaesthesiol. 2001;14:559-562.

van Klei WA, Moons KG, Rutten CL. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg. 2002;94:644-649.

Pollard JB, Zboray AL, Mazze RI. Economic benefits attributed to opening a preoperative evaluation clinic for outpatients. Anesth Analg. 1996;83:407-410.

Power LM, Thackray NM. Reduction of preoperative investigations with the introduction of an anaesthetist-led preoperative assessment clinic. Anaesth Intensive Care. 1999;27:481-488.

Silvestri L, Maffessanti M, Gregori D. Usefulness of routine preoperative chest radiograph for anaesthetic management: a prospective multicentre pilot study. Eur J Anaesthesiol. 1999;16:749-760.

Fischer SP. Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology. 1996;85:196-206.

Ferschl MB, Tung A, Sweitzer B. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology. 2005;103:855-859.

Pollard JB, Garnerin P, Dalman RL. Use of outpatient preoperative evaluation to decrease length of stay for vascular surgery. Anesth Analg. 1997;85:1307-1311.

Gibby GL. How preoperative assessment programs can be justified financially to hospital administrators. Int Anesthesiol Clin. ;40:17-30.

Tsen LC, Segal S, Pothier M. Survey of residency training in preoperative evaluation. Anesthesiology. 2000;93:1134-1137.

Kluger MT, Tham EJ, Coleman NA. Inadequate pre-operative evaluation and preparation: a review de 197 reports from the Australian incident monitoring study. Anaesthesia. 2000;55:1173-1178.

Boothe P, Finegan BA. Changing the admission process for elective surgery: an economic analysis. Can J Anaesth. ;42:1995.

Pollard JB, Olson L. Early outpatient preoperative anesthesia assessment: does it help to reduce operating room cancellations?. Anesth Analg. 1999;89:502-505.

Egbert LD, Battit GE, Turndorf H. The value of the preoperative visit by an anesthetist: A study of doctor-patient rapport. JAMA. ;1963:553-555.

Klafta JM, Roizen MF. Current understanding of patients' attitudes toward and preparation for anesthesia: a review. Anesth Analg. 1996;83:1314-1321.

Macuco MV, Macuco OC, Bedin A. Efeito de um consultório de Anestesiologia sobre as preocupações, percepções e preferências relacionadas à anestesia: Comparação entre o sexo masculino e feminino. Rev Bras Anestesiol. 1999;49:179-189.

Hepner DL, Bader AM, Hurwitz S. Patient satisfaction with preoperative assessment in a preoperative assessment testing clinic. Anesth Analg. 2004;98:1099-1105.

Twersky RS, Lebovits A, Lewis M. Early anesthesia evaluation of the ambulatory surgical patient: does it really help?. J Clin Anesth. 1992;4:204-207.

Arellano R, Cruise C, Chung F. Timing of the anesthetist's preoperative outpatient interview. Anesth Analg. 1989;68:645-648.

Macario A, Vitez TS, Dunn B. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995;83:1138-1144.

Roizen MF, Klock PA, Klafta J. How much do they really want to know? Preoperative patient interviews and the anesthesiologist. Anesth Analg. 1996;82:443-444.

Finegan BA, Rashiq S, McAlister FA. Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests. Can J Anaesth. 2005;52:575-580.

Katz RI, Barnhart JM, Ho G. A survey on the intended purposes and perceived utility of preoperative cardiology consultations. Anesth Analg. 1998;87:830-836.

Lee T, Pappius EM, Goldman L. Impact of inter-physician communication on the effectiveness of medical consultations. Am J Med. 1983;74:106-112.

Rudd P, Siegler M, Byyny RL. Preoperative diabetic consultations: a plea of improved training. J Med Educ. 1978;53:590-596.

Park KW. Preoperative cardiology consultation. Anesthesiology. 2003;98:754-762.

Katz RI, Cimino L, Vitkun AS. Preoperative medical consultations: impact on perioperative management and surgical outcome. Can J Anaesth. 2005;52:697-702.

5dd840460e88259d5c13f288 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections