Plastic Reconstructive and Aesthetic Surgery: The Essentials by Seth R. Thaller, Deniz Dayicioglu, John C. Oeltjen, Kenneth

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Schimpf (Continued) There was poor granulation and wound bed preparation, with persistent osteomyelitis and areas of radiation necrosis. Pt now agreed to free flap reconstruction. Debridement with craniectomy was done with a free rectus abdominis and STSG reconstruction. indd 18 6/21/2012 7:37:37 PM b1289 Essentials of Plastic Surgery Grafts and Flaps 19 Pt healed well and was pleased with the results. A contour deformity remained, however he declined subsequent calvarium reconstruction. indd 19 6/21/2012 7:37:45 PM b1289 Essentials of Plastic Surgery 20 J.

Meeting the standard of care is the minimum requirement of our practice. The American Society of Anesthesiologists (ASA) has issued practice guidelines, standards of care, positions, and statements regarding the safe practice of anesthesia. Providers are encouraged and invited to review and practice “safe anesthesia” under these parameters. indd 29 6/21/2012 7:39:42 PM b1289 Essentials of Plastic Surgery 30 G. Paparcuri & M. Cobas Preoperative Evaluation Patients coming for elective plastic surgery are usually healthy Most cosmetic procedures constitute elective surgeries and mandates appropriate patient optimization Preoperative patient evaluation includes a thorough history and physical examination Diligent perioperative care avoids postoperative complications ASA basic standards for preanesthesia care and goals1 • • • • • • • • • • Reduce patient’s psychological and physiological anxiety Review available medical records Assess health status and physical readiness for scheduled surgery Order and review pertinent available tests and consultations Define therapeutic and monitoring strategies for the proposed anesthesia and surgery Plan postoperative care and pain therapy Order appropriate preoperative medications Obtain informed consent for anesthesia (include type of anesthesia and the most common and severe possible complications) Document in the chart that the above has been performed Coordinate patient care in a way that decreases total cost and improves outcomes Although most of these patients have been cleared by their primary care physicians, regardless of what the surgeon has planned or what the specialists have cleared the patient for, the ultimate decision of whether or not to proceed with the case is always in the hands of the person in charge of the anesthetic care.

Fasting recommendations Summary of ASA Fasting Recommendations to Reduce the Risk of Pulmonary Aspiration:*5 Ingested material ‡ Minimum fasting period (h) Clear liquids 2 Breast milk 4 Infant formula 6 Non human milk 6 ¶ Light meal 6 *These recommendations apply for healthy patients who are undergoing elective procedures. Following the Guidelines does not guarantee complete gastric emptying. ‡ Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee.