Pre-Anesthesia Testing (PAT) Resources

Scheduling & PAT Guidelines

All patients having surgery at WakeMed require either a Pre-Anesthesia and Testing (PAT) telephone call or PAT Clinic visit prior to the day of surgery to allow for thorough preoperative evaluation, diagnostic testing and education.

PAT Clinic Visit should be scheduled within 30 days of the surgery at the time of surgery scheduling. Offices must use the PAT Triage Questionnaire to determine if a patient requires a PAT visit or if a Phone Call is sufficient.

If, during a telephone PAT interview, the patient is found to require a PAT Clinic Visit, then the clinic appointment will be scheduled with the patient at that time.

All patients being scheduled for surgery must be screened in your office using the triage questionnaire and scheduled for a Clinic visit if medically appropriate. In addition, patients with multiple medical problems frequently benefit from a PAT clinic visit, even if they don’t meet specific criteria.

If a patient with known medical problems does not attend a scheduled PAT clinic appointment, your office will be contacted to reschedule the patient for a different surgery date/time.

• Anesthesiology Outpatient Pre-Op Standing Orders Worksheet
• Consent for Surgery and Special Procedures
• PAT Surgery Triage Questionnaire
• PAT GI Triage Questionnaire

Summary of Fasting (NPO) Guidelines to Minimize the Risk of Pulmonary Aspiration

Ingested Material Minimum Fasting Period

• Clear Liquids - up to 3 hours before your surgery and up to 1 hour before you arrive at WakeMed
• Breast Milk - up to 4 hours before you arrive at WakeMed
• Infant Formula - up to 6 hours before you arrive at WakeMed
• Other liquids and solids - 8 hours before you arrive at WakeMed

For elective procedures requiring general and regional anesthesia or monitored anesthesia care (MAC)

For Adult Patients:

• Nothing to eat after midnight the night before scheduled procedures
• Patients may have clear liquids up to 3 hours before your surgery and up to 1 hour before arriving at WakeMed

For Pediatric Patients:

• Nothing to eat after midnight
• Formula fed babies may have last bottle up to 6 hours before scheduled arrival time
• Breastfed babies may nurse up to 4 hours before scheduled arrival time
• All pediatric patients may have clear liquids up to 3 hours before surgery and up to 1 hour before arriving at WakeMed

Clear Liquids Include:

• Water
• Black coffee and sugar; no cream or milk
• Tea and sugar; no cream or milk
• Soft drinks
• Apple juice; no pulp
• Powerade/Gatorade or other high carbohydrate nutritional drinks
• Do not drink alcohol, orange juice, gelatin, clear protein drinks or broth

The above guidelines have been established to minimize the risk of life-threatening pulmonary aspiration during elective surgery. Following these guidelines does not guarantee complete gastric emptying.

• Fasting Directions Before Surgery

Preoperative Cardiac Evaluation

The following patients must have a preoperative cardiac evaluation by a cardiologist prior to all surgery procedures:

• Patients who have undergone placement of a coronary artery stent in the last 12 months.
• Patients who are on Plavix for protection of a coronary stent placed at any time in the past.

If a patient with any of these problems does not have the appropriate preoperative evaluation and documentation, the procedure will be cancelled on the day of surgery. Patients with a history of cardiovascular disease will need preoperative cardiac evaluation prior to most procedures. This includes history of the following:

• Coronary artery disease (including angioplasty, stents, or bypass surgery)
• Congestive Heart Failure
• Heart valve disease
• Arrhythmias (atrial fibrillation, supraventricular tachycardiac (SVT), Wolff-Parkinson-White)
• Stroke

Please facilitate the preoperative evaluation process by having the patient see the cardiologist before the PAT clinic visit and ensuring that the necessary documentation is completed and sent to the PAT clinic prior to the PAT clinic appointment. The process for obtaining preoperative cardiac evaluation is as follows:

1. Surgeon’s office schedules appointment with the cardiologist, completes the top of the Request for Preoperative Cardiac Evaluation Form (form N-372, shown below) and faxes to cardiologist. An electronic copy of this form can be found here

2. Cardiologist performs evaluation, completes pertinent section of the form, and returns the form and consult to surgeon’s office.

3. Surgeon’s office completes remainder of the form and faxes copy of form and cardiology materials to WakeMed pre-op clinic.

Perioperative Management of Pacemakers and ICDs

WakeMed Perioperative Services has collaborated with physicians from the Departments of Anesthesiology and Cardiology create a process by which patients with implanted pacemakers and defibrillators are managed during the perioperative period. 

Summary:

• Any patient with a pacemaker or defibrillator (ICD) device must be scheduled for a PAT clinic visit, with the exception of cataract patients and screening endoscopy.
• If perioperative device reprogramming is necessary on the day of surgery, WakeMed will arrange this with the device representative.
• The information Request for Outpatient Preop Pacemaker/Defibrilator (N-765) form is sent to the cardiologist who manages the patient’s device, not necessarily the patient’s primary cardiologist.
• This process is best initiated by the surgeon’s office prior to the PAT clinic visit to ensure that information is available at the time of the visit.

Pediatric Preoperative Diagnostic Testing Guidelines

Normal CBC results are valid for six months.

Pediatric Patients under the age of 13 should be scheduled for a Phone Call PAT telephone interview with the parent which will be carried out by a WakeMed PAT nurse.

If the nurse identifies any severe medical conditions or anesthesia related problems, the anesthesiologist will be 
notified and additional information may be requested from either your office or the child’s pediatrician.

Any pediatric patient with active medical problems unrelated to the surgery, such as an active respiratory tract infection, severe asthma, congenital heart disease or neurological disease should be referred to their pediatrician or pediatric subspecialist for preoperative evaluation and optimization. Documentation of the encounter should be faxed to WakeMed.