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Preoperative care of a neurologic patient concerns attention to the following points:
• Determination of the physician responsible for instructions: neurologist, neurosurgeon, anesthetist, or an internist in case the patient has disease of another system that requires attention during the procedure.
• Procedure as inpatient or outpatient (ambulatory).
• Nothing per oral (NPO), particularly with regards to fluids and oral medications.
• Preparation varies according to the nature of the procedure. It may be a noninvasive procedure to be performed by the neurologist such as transcranial magnetic stimulation, minimally invasive interventional neuroradiological procedure, deep brain stimulation, implantation of a device for neuromodulation, or neurosurgery in which case the patient is transferred to neurosurgical service.
• Procedure to be performed under local anesthesia, intravenous, or inhalation general anesthesia. The anesthetist is involved if regional block or general anesthesia is to be used. For an ambulatory patient, the anesthetist, in collaboration with the physician or surgeon performing the procedure, issues instructions for preoperative preparation.
A neurologist should be familiar with the preoperative preparation, particularly where the patient remains in the neurology service of a hospital or under the care of a neurologist in private practice outside. Preparation for a procedure involves review of medications to decide which can be continued or stopped. The focus of this article is the preparation of a patient for neurologic procedures. However, a neurologic patient may develop a disorder of another system that requires urgent surgery and go directly to the operating room prior to transfer to another department.
• Preprocedural or preoperative preparation of a neurologic patient usually includes nothing by mouth orders if the procedure is performed under anesthesia.
• Duration of fasting has been modified over the past years and has been shortened.
• An important step is checking the list of medications of a patient to decide which can be continued or withheld.
• Attention to patient’s condition and suitability for a procedure needs to be checked.
• Some laboratory tests may reveal findings that have an outcome of the procedure.
Historical note and terminology
Fasting prior to a medical procedure is an established concept that arises from the patient safety tradition of anesthesia. Since Mendelson’s original description over 75 years ago (05), there has been a presumed link between the quantity and quality of gastric contents and the risk of aspiration and death with anesthesia. Preoperative fasting, referred to as NPO (Latin “nil per os” translated to “nothing by mouth”), is defined as a prescribed period of time before a procedure when patients are not allowed the oral intake of liquids or solids. The term “preoperative” should be considered synonymous with “preprocedural,” as the latter term is often used to describe procedures that are not considered to be operations. Anesthesia care during procedures refers to general anesthesia, regional anesthesia, or procedural sedation and analgesia. It does not include local anesthesia, although nothing per oral is recommended to avoid nausea or vomiting resulting from the procedure or adverse effect of the local anesthetic.
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