Preoperative assessment and optimization

Intraoperative anesthetic care is dictated by a number of factors. An understanding of the patient's medical status and reserve is critical in the planning and administration of a successful anesthetic that idealizes surgical conditions while optimizing patient safety. The preoperative evaluation and medical optimization of the patient presenting for otolaryngology procedures is central to the role of the anesthesiologist, and it is essential that all otolaryngologists have a working knowledge of the concepts and importance of the preoperative patient assessment. While the focus of this chapter is medical in nature, the psychological and potential medical-legal importance of a thorough preoperative visit cannot be overstated. Most patients admit to being more frightened of the anesthetic than the surgery and the ability of the anesthesiologist to gain the patient's trust and alleviate their anxiety while simultaneously obtaining a pertinent anesthetic history and physical, and informing them of the likely risks and benefits of the proposed anesthetic and monitoring, is equally important as is administering sound intraoperative care.