Roles for Anesthesiologists in the Future of Medicine in the United States

Alex S. Evers, MD; Jeanine P. Wiener-Kronish, MD

Disclosures

Anesthesiology. 2022;134(2):231-233. 

In This Article

We Can Also use our Current Platform to Improve the Safety and Outcomes of Transitions Between Preventative/Chronic Care and Acute Care

Preoperative evaluation provides unique opportunities to review patient health status and treatment at a critical moment in their lives. Unfortunately, this remains a largely unrealized opportunity, likely due to high costs and limited revenue opportunities. Many patients interact with the health care system only at the time of a surgery or procedure, providing an opportunity to identify and rectify long-term medical issues. For other patients, preoperative evaluation serves as a critical interface between preventative and chronic care and acute care. Preoperative evaluation provides substantial opportunities to improve surgical outcomes, including the following:

  1. Identify risks and inform patients. For patients who cannot make their own decisions or have multiple comorbidities, anesthesiologists need to be part of the perioperative establishment of goals, including the plans for resuscitation during or after anesthesia.

  2. Adjust chronic therapy for safety during an episode of surgical care. Many outpatient treatments are hazardous or require adjustment to accommodate the circumstances and stresses of a major procedure. For example, acute interventions, such as stopping sodium-glucose transport protein 2 (SGLT2)-inhibitors 3 to 4 days before surgery or other procedures can prevent postoperative ketoacidosis.[6]

  3. Identify problems that may require modification to ensure optimal health. For example, recognition of severe pulmonary hypertension can lead to using open abdominal surgery rather than insufflation of the abdomen, thus preventing heart failure. A major surgery can also be an emotional pivot point for patients, allowing interventions to alter unhealthy behaviors, such as smoking, substance abuse, and poor nutrition. Furthermore, for patients with poor functional status, prehabilitation may provide a more systematic approach to exercise, nutrition, and psychological issues and help to improve perioperative outcomes and general health for frail preoperative patients.

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