First among Standards of the American Society of Anesthesiologists is Basic Standards of Preanesthesia Care.<sup>2 American Society of Anesthesiologists Standards, Guidelines, and Statements : American Society of Anesthesiologists (1998).  2

Cliccare qui per andare alla sezione Riferimenti</sup> Approved by the American Society of Anesthesiologists (ASA) House of Delegates on October 14, 1987, these standards are considered “minimum requirements for sound practice” based on “generally accepted principles for patient management.”

As stated in the guidelines, “An anesthesiologist shall be responsible for determining the medical status of the patient, developing a plan of anesthesia, and acquainting the patient or the responsible adult with the proposed plan.” The standards call for a review of medical records; an interview and examination of the patient; a discussion of the patient's medical history, previous anesthetic experiences, and current drug therapy, and provisions for obtaining and reviewing laboratory and diagnostic tests indicated for the conduct of anesthesia. They also require that the responsible anesthesiologist verify that the above requirements have been “properly performed and documented in the patient's record.” They provide for modification and documentation of the reasons for modification in the patient's record under unusual circumstances, such as extreme emergencies.

Can the official statement of the ASA on the subject of preoperative preparation be summarized? How these standards can be best implemented is a subject of debate. Some authors believe that a preinduction assessment satisfies these requirements; others advocate a preparation process that begins days before a planned anesthetic.<sup>35 Roizen M.F. More preoperative assessment by physicians and less by laboratory tests [editorial; comment] N Engl J Med 2000 ;  342 : 204-205  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Common sense and experience suggest that these published standards do not address the full range of possible issues surrounding preoperative preparation.

Changes in health care delivery, health assessment standards, information management, and perioperative care patterns have resulted in the reconceptualization of virtually every aspect of preoperative preparation. The vocabulary used to discuss issues has changed to reflect the shifting emphases of perioperative care better. In a report due in 2000 from the Task Force on Preanesthesia Evaluation, the ASA is expected to make an expanded statement on what constitutes acceptable preanesthetic care.

In this article, preoperative preparation is presented as having distinct but overlapping preanesthetic and preprocedural components. Value is discussed, and the roles of various perspectives are considered as determinants of the practices that shape the structure and function of preparation processes. Preanesthesia preparation then is discussed as a practical activity. A discussion of future issues concludes this article.