PORA

The nature of anaesthetists’ training and experience makes them uniquely qualified to assess the inherent risks of anesthetizing each individual patient.Ideally, every patient should be seen by an anaesthetist prior to surgery to identify, manage and minimize these risks. Traditionally, this occurred when the patient was admitted, usually the day before an elective surgical procedure. However, if at this time the patient was found to have any significant comorbidity, surgery was often postponed but with insufficient time to admit a different patient, leading to wasted operating time. Increasingly, in attempts to improve efficiency, patients are admitted on the day of their planned surgical procedure. This further reduces the opportunity for an adequate anaesthetic assessment, limits the investigations that can be done and virtually prevents optimization of any comorbidities. This has led to significant changes in the preoperative management of patients undergoing elective surgery, including the introduction of clinics specifically for anaesthetic assessment. A variety of models of ‘preoperative’ or ‘anaesthetic assessment’ clinic exist. Pre Anaesthetic assessment is by far the most crucial step in analysing the type of anaesthesia that can be given to the patient and predicating the outcome of the surgical procedure under anaesthesia,so as to prepare the patient adequately for the surgery.The conventional method of pre anaesthetic assessment involves various factors including the history,comorbidities,systemic examination ,vitals,airway assessment and investigations to predict the ASA grade of the patient ,which vaguely predicts the outcome post surgery.While this has been used for years,it has so many subjective variables and doesn’t incorporate a lot of factors that could play a role in altering the outcome post surgery.Hence we have devised an application to that incorporates Nineteen pre operative parameters with a scoring system(including all the parameters in the conventional method) that helps in risk stratifying the patients based on the score.
The Application contains a questionnaire with Nineteen pre operative questions having multiple options to choose, with a preassigned score to each option.The scores are added up by the application and they are categorized in to particular risk category depending on the score.
Then the patient will be shifted to the operation theatre, electrocardiogram, noninvasive blood pressure, pulse oximetry, and capnography monitor will be connected. Then anesthesia of choice will be administered as per institutional protocol and standard of care.During the intra operative period Six parameters with scores assigned to each and during post operative period eleven post operative parameters with specific scores have also been included in the app that outlines the outcome of the surgery.The already stratified preoperative risk is then compared with the post operative outcome.