Therapeutische Umschau. Revue thérapeutique
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Often, patients with neurological diseases need to undergo surgical procedures. The most frequent are orthopaedic surgery (tenotomies, corrections of articulations), urological procedures (for instance, sphincter surgery for urinary incontinence), ENT surgery (tracheotomy), or plastic surgery for closure of decubitus ulcers. Preoperatively, these patients need a careful check-up including a thorough drug history. ⋯ A close collaboration between general practitioner and anaesthesiologist is warranted. It cannot be excluded that symptoms of the neurological disease will deteriorate postoperatively due to anaesthesia, surgery or perioperative stress. Medication that is used to control symptoms of a neurological disease should not be stopped in the perioperative period.
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Anaesthetists often visit their patients in exceptional situations characterised by preoperative anxiety or distress. Therefore, even brief contact with the patient can be considered intense and meaningful. The initial preoperative anaesthetic visit is the beginning of the relationship between patient and anaesthetist, and should help to explain the planned anaesthetic technique. ⋯ Today, there is in general a shift away from decisions made solely by physicians, reflecting an increased respect for the autonomy of the patient towards a model of shared decision-making and informed choice. Ideally, the preoperative visit follows the four key habits of highly effective clinicians, i.e., to rapidly establish a rapport with the patient and provide an agenda for the visit, to explore the patient's perspectives and expectations, to demonstrate empathy, and to focus on the end of the visit with providing information and including the patient in the decision-making process. Visits are then concluded upon obtaining informed consent from the patient.