《接受择期非心脏手术的成人术前评估：欧洲麻醉学与重症监护学会更新指南》
背景：
在考虑患者是否适合手术时，全面的患者评估是麻醉医师评估手术相关风险以及患者潜在疾病，并（在可能的情况下）优化围手术期手术过程的第一步。欧洲麻醉学与重症监护学会（ESAIC）的这些指南更新了先前的指南，就考虑患者手术路径不同方面的现有和新兴主题提供了新证据。
设计：
进行了一次全面的文献综述，重点关注组织、临床方面、优化和规划。使用 GRADE（推荐分级、评估、制定与评价）方法评估所纳入研究的方法学质量。通过德尔菲法确定了推荐的措辞，以及由最少证据支持的临床实践声明（CPS）。指南的草稿版本在 ESAIC 网站上发布了 4 周，并将链接分发给所有 ESAIC 个人和国家成员，包括大多数欧洲国家麻醉学会。收集反馈并相应地纳入指南。在草稿最终确定后，指南委员会和 ESAIC 理事会正式批准了该指南。
结果：
在指南更新的第一阶段，最初确定了 17668 个标题。在去除重复项并将搜索期间限制在 2018 年 1 月 1 日至 2023 年 5 月 3 日之后，标题数量减少到 16774 个，然后进行筛选，得到 414 个摘要。其中，确定了 267 个相关摘要，从中选择了 204 个合适的标题进行全面的 GRADE 分析。此外，该研究考虑了 4 篇综述、16 篇荟萃分析、9 篇先前发布的指南、58 项前瞻性队列研究和 83 项回顾性研究。该指南提供了 55 项基于证据的推荐，这些推荐通过德尔菲法进行了投票，达成了坚实的共识（>90%的一致同意）。
讨论：
本次对先前指南的更新涵盖了术前麻醉评估的新组织和临床方面，以便对术后并发症高风险需要重症监护的患者进行更客观的评估。远程医疗以及更具预测性的术前评分和生物标志物应指导麻醉医师为每位患者选择适当的术前血液检查、X 光检查等，使麻醉医师能够评估风险并提出最合适的麻醉计划。
结论：
每位患者都应该对其接受需要麻醉医师参与的手术的适合性进行量身定制的评估。在这个阶段，麻醉医师的作用至关重要，以获得对患者临床状况的广泛了解、协调护理并帮助患者做出明智的决定。
Preoperative assessment of adults undergoing elective noncardiac surgery: Updated guidelines from the European Society of Anaesthesiology and Intensive Care
Background:
When considering whether a patient is fit for surgery, a comprehensive patient assessment represents the first step for an anaesthetist to evaluate the risks associated with the procedure and the patient's underlying diseases, and to optimise (whenever possible) the perioperative surgical journey. These guidelines from the European Society of Anaesthesiology and Intensive Care Medicine (ESAIC) update previous guidelines to provide new evidence on existing and emerging topics that consider the different aspects of the patient's surgical path.
Design:
A comprehensive literature review focused on organisation, clinical facets, optimisation and planning. The methodological quality of the studies included was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. A Delphi process agreed on the wording of recommendations, and clinical practice statements (CPS) supported by minimal evidence. A draft version of the guidelines was published on the ESAIC website for 4 weeks, and the link was distributed to all ESAIC members, both individual and national, encompassing most European national anaesthesia societies. Feedback was gathered and incorporated into the guidelines accordingly. Following the finalisation of the draft, the Guidelines Committee and ESAIC Board officially approved the guidelines.
Results:
In the first phase of the guidelines update, 17 668 titles were initially identified. After removing duplicates and restricting the search period from 1 January 2018 to 3 May 2023, the number of titles was reduced to 16 774, which were then screened, yielding 414 abstracts. Among these, 267 relevant abstracts were identified from which 204 appropriate titles were selected for a comprehensive GRADE analysis. Additionally, the study considered 4 reviews, 16 meta-analyses, 9 previously published guidelines, 58 prospective cohort studies and 83 retrospective studies. The guideline provides 55 evidence-based recommendations that were voted on by a Delphi process, reaching a solid consensus (>90% agreement).
Discussion:
This update of the previous guidelines has covered new organisational and clinical aspects of the preoperative anaesthesia assessment to provide a more objective evaluation of patients with a high risk of postoperative complications requiring intensive care. Telemedicine and more predictive preoperative scores and biomarkers should guide the anaesthetist in selecting the appropriate preoperative blood tests, x-rays, and so forth for each patient, allowing the anaesthetist to assess the risks and suggest the most appropriate anaesthetic plan.
Conclusion:
Each patient should have a tailored assessment of their fitness to undergo procedures requiring the involvement of an anaesthetist. The anaesthetist's role is essential in this phase to obtain a broad vision of the patient's clinical conditions, to coordinate care and to help the patient reach an informed decision.
