Preanesthesia evaluation for ambulatory surgery: Do we make a difference?

PURPOSE OF REVIEW: Ambulatory surgery is considered low risk; however, both surgery-related and patient-related factors combine to determine the overall risk of a procedure. The preanesthesia evaluation is useful to gather information and determine whether additional testing or medical optimization is necessary prior to surgery with the goal to prevent adverse events and improve outcomes. RECENT FINDINGS: Recent literature focused on the preanesthesia evaluation provides guidelines for patient-centered testing. Routine, protocolized preoperative testing is expensive and has not shown to improve outcomes. The preanesthesia visit is useful for patient evaluation, not specifically testing, but for the synthesis of information, medical optimization, additional targeted testing if indicated, assessment of risk, and plan for perioperative management. SUMMARY: Current literature supports a preanesthesia visit that focuses on individual patient evaluations and patient-directed effective interventions. This is in contrast to the previous routine, protocolized preoperative preparations. The challenge for anesthesiologists lies in understanding both surgery-specific and patient-specific risk factors, and targeting interventions to optimize the outcomes.