Anesthesia Student Survival Guide.pdf - Index of

86 ● AnesthesiA student survivAl Guide
The Interview
Among the most vital parts of the preoperative evaluation is the development
of strong rapport with the patient. Fear, anxiety, uncertainty, loss of control,
and/or vulnerability are common emotions experienced by surgical patients.
A high state of anxiety can have a detrimental effect on the recovery process.
Studies have shown that well-informed patients experience less anxiety, are
more easily mobilized, tend to be more satisfied with the care they receive, and
report better overall postoperative well-being. Therefore, the development of
a confident doctor–patient relationship can provide a strong foundation for
good patient care and outcomes.
History and Physical
History
Obtaining a pertinent history and physical is an essential part of tailoring the
anesthetic plan. A systematic approach to collecting patient history is often
used to make sure that all relevant topics are covered.
Airway
The majority of anesthetic complications are due to respiratory injuries. Among
the causes of the respiratory injury are inadequate ventilation, esophageal
intubation, and difficult tracheal intubation. Since 17% of respiratory related
injuries are due to difficult intubation, and up to 28% of all anesthesia-related
deaths are due to the inability to mask-ventilate or intubate, recognizing a
potential difficult airway in the preoperative evaluation holds great importance.
It is important to question the patient about any prior anesthetics and any
history of difficult intubation or mask ventilation.
Physical factors affecting mask ventilation can be determined from age and
physical history as shown in the list below. If the likelihood of a difficult mask
Factors Affecting Mask Ventilation
• Presence of a beard
• BMI> 26 kg/m2 • Missing teeth
• Age> 55
• History of snoring
Adapted from Langeron, O. Prediction of difficult mask ventilation. Anesthesiology 200; 92:1229.