Pre-operative Assessment and Patient Preparation video transcript

Hello and welcome to 21 Portland Place, the headquarters of the Association of Anaesthetists of Great Britain and Ireland. I’m Will Harrop-Griffiths, I’m vice-president of the association and with me today is Dr Ranjit Verma. Dr Verma was chairman of the working party that has produced of the association’s latest safety guidelines entitled ‘Pre-operative assessment and patient preparation’.

Dr Verma, good morning. Good morning. Ranjit surely anaesthetists are surely just the people who keep us asleep during operations. Why do they have to see patients beforehand? Anaesthetists have a far greater responsibility than putting a patient to sleep and waking them up. They have a responsibility to make sure that they do of course wake up at the end of the procedure but also to make sure that the patient is adequately prepared so that the risks associated with anaesthesia are minimised as far as possible.

Now I understand that your guideline document makes a lot of mention of pre-assessment clinics. What are pre-assessment clinics? Pre-assessment clinics are as the name applies, hospital based clinics essentially where there is a team of people which involves not just the anaesthetist but also the specialised nurses, other staff dealing with the patient who can not only assess the patient but make sure that their level of fitness is as optimal as possible to make sure that the patient understands what they’re coming in for, what is going to be done for them and of course to give the patient an opportunity to ask questions.

So what happens if the patient isn’t very fit, what happens to them in the pre-assessment clinic? This depends of course on the individual patient and how unfit, if I may use that term, they are. If it’s a relatively minor thing then that can be addressed. Either then and there by advice from the pre-operative assessment team or they can be filtered back to the general practitioner for example if a patient has high blood pressure it would be unsafe to carry on and give that patient an anaesthetic, if surgery can be avoided and in that situation one would recommend that they start some appropriate treatment monitored by the GP, bring the blood pressure into normal levels and then come into the surgery. So things like that can be addressed. If they are more seriously ill or if there are more serious problems with the individual then the patient may need further investigation and treatment before surgery can be proceeded safely.

Do patients also get the opportunity to talk to the nurses and the anaesthetist about the details of what’s going to happen to them during, before and after the operation? This is very much part of the pre-operative assessment process. The patient is given opportunity to ask questions and to highlight any fears or anxieties that they may have which can be addressed appropriately.

Should every patient who’s undergoing surgery go through a pre-assessment clinic? The problem we have at the moment is that many hospitals do not have a pre-operative assessment clinic per se, although most of them have mechanisms whereby patients can be assessed pre-operatively. This may involve contact with the specialised nurses who have trained in this field, so to answer your question, although it may not be practical for them to go to a clinic because the clinic doesn’t exist but they should have an opportunity to speak to somebody who is involved with the pre-operative assessment process beforehand.

Do the nurses and anaesthetists who work in the pre-assessment clinics need special training? The doctors who train as anaesthetists go through a long and rigorous process of training and it is part and parcel of the training that they learn about pre-operative assessment and to evaluate and judge the risks for the patient who is to undergo anaesthesia. Nurses of course are a different kettle of fish, nowadays there is a lot of interest in extended roles of nurses, where train either formally through courses which can be national or local whereby they develop special interested and expertise in different fields and nurses with interest in pre-operative assessment fall into one of those categories.

Does every hospital in this country have a pre-assessment clinic?

Not every hospital in this country has a pre-operative assessment clinic. But our working party recommends that most departments of anaesthesia should consider setting one up. This of course will require a great deal of support from management because these things are not cheap and have to be funded appropriately. Are you saying in effect that there is insufficient funding for these clinics in the UK? I think that’d be fair to say yes.

Two final quick questions.

If I go to pre-assessment clinic can I ask for a particular sort of anaesthetic to be planned as part of my surgery so if I want a local anaesthetic or an epidural, is that the time to ask an anaesthetist for that type of anaesthetic? You have to realise that the pre-operative assessment process is a team approach or should be a team approach that involves not only the surgeon and the anaesthetist and the nurse and the theatre staff but very much involves the patient as well. There is no harm in requesting a particular type of anaesthetic but the decision of exactly what type of anaesthesia to administer or to give to you will depend on several factors and all members of this team will need to think it through and come to a consensus and opinion which would ensure the best quality of anaesthesia and the safest route by which you can have your operation. Are you saying that it’s not my decision? I think the choice of anaesthetic depends on the advice that the professionals are able to give to you and the ultimate decision has to be that of the patient but it has to be based on appropriate advice given from all members of the team that are involved with the pre-operative assessment and particularly the individual needs to understand and appreciate the risks involved in different types of anaesthesia and it is only once that you have received all the information that you can make an informed choice.

Ranjit, one final question. As a patient presenting for surgery and possibly to the pre-assessment clinic, what can I do about my own lifestyle that could decrease the risk of surgery. There are several simple things that individuals can do to enhance safety and promote a safer anaesthetic. Improvement in general fitness is the commonest so things like if you smoke you should stop smoking. If you’re overweight you need to address that issue and perhaps loose some weight and improve your fitness level and so on. And then it’s important to go and see your GP and if there are any simple issues that can be addressed relatively easily such as high blood pressure and so on, all these things need to be addressed before the surgery is undertaken.

Well Ranjit I’d like to thank you very much for coming here today to 21 Portland Place, the headquarters of the association of anaesthetists to discuss the latest AAGBI safety guideline on pre-operative assessment and patient preparation. Copies of the guideline will be sent out to the association and the guideline is available for download as a PDF from

Pre-operative Assessment and Patient Preparation video

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