Preoperative assessment of the adult patient

Tests should be ordered only as indicated. History and physical examination should precede laboratory studies. Variability of spinal anatomy and physiology dictate that cases involving spine surgery should be considered on an individual basis. General “cardiac clearance” is rarely useful. Many diseases and comorbidities involve the spine and must be considered separately. Introduction Procedures on the spine vary in complexity from simple discectomy to multi level reconstruction and fusion with instrumentation. Moreover, the level of surgery from the cervical area to the coccyx further impacts planning for anesthetic management. Procedures may be planned for months or occur emergently as part of multiple trauma. Thus many factors determine appropriate preoperative anesthetic assessment. General guidelines In 2002 the American Society of Anesthesiologists developed a practice advisory to assist in decision making regarding appropriate preanesthetic assessment and care. The advisory is the synthesis of opinions from experts, open forums, public sources, and literature review. It is to be applied to all anesthesiologists and those who provide care under the direction of an anesthesiologist including residents, certii ed registered nurse anesthetists (CRNA) or students. It applies to all age groups and all types of anesthesia and deep sedation for both surgical and nonsurgical situations. The advisory does not address emergency situations.