Anesthetic Plan

In constructing the plan, the anesthetist uses the preoperative evaluation of the patient to match the technical requirements of the surgical procedure and the physiologic characteristics of the patient to the mental, physical, and technological resources available. A typical anesthetic plan contains several elements. For example, the plan for general anesthesia includes choices for the means of inducing anesthesia, securing the airway and ensuring proper ventilation, maintaining anesthesia, conducting emergence from anesthesia, and postoperative pain control. Skilled planning is as critical in safe patient care as is skilled execution. If a significant feature of the situation is missed in formulating the plan, it can leave the patient vulnerable, regardless of how adeptly the plan is implemented.

The technical requirements of most surgical procedures are well known. Most patients do not have medical problems that could significantly alter the anesthetic plan, although Gibby and coworkers^[188] found that 20% of outpatients, most of them with American Society of Anesthesiologists (ASA) physical status 1 or 2, had conditions identifiable through an anesthetist's history and examination that required changes from a "standard" anesthetic plan. When a procedure is new or challenging, when the patient has significant underlying disease, or when needed resources are not available, creative planning may be needed to identify a set of physiologic goals for the anesthetic regimen. Routine anesthetic plans can be modified or combined to produce a compromise plan that best fits the goals and constraints of the situation.

Although faculty anesthetists routinely critique the anesthetic plans of residents, and planning is explicitly probed during the oral examination of the American Board of Anesthesiologists, the process of constructing anesthetic plans has been studied very little. Most of the existing literature on preoperative planning concentrates only on the medical and physiologic aspects of underlying diseases and their anesthetic ramifications.