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Give me the millers definition of PAC

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Could you specify what PAC stands for in the context you're asking about? For example:
  • Pulmonary Artery Catheter
  • Perianesthesia Care
  • Post-Anesthesia Care
  • Something else entirely?
This will help me pull the exact definition from Miller's textbook.

Pre anaesthesia checkup

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I now have the full definition and goals directly from Miller's Anesthesia. Here is the answer:

Pre-Anesthesia Evaluation (PAC) — Miller's Anesthesia (10th Edition)

Definition / Overarching Goals

According to Miller's Anesthesia (10e), the pre-anesthesia evaluation has two core goals:
(1) Ensure that the patient can safely tolerate anesthesia for the planned surgery, and (2) mitigate perioperative risks such as pulmonary or cardiovascular complications.

What PAC Encompasses

The pre-anesthesia evaluation offers opportunities to:
  • Perform focused clinical examinations
  • Better document comorbid illness
  • Reduce patient and family anxiety through education
  • Optimize pre-existing medical conditions
  • Make selective referrals to medical specialists (e.g., cardiologists)
  • Order specialized investigations (e.g., cardiac stress tests)
  • Initiate risk-reduction interventions
  • Discuss aspects of perioperative care (anticipated risks, fasting guidelines)
  • Arrange appropriate levels of postoperative care (e.g., ICU)
  • In very high-risk patients — recommend consideration of nonoperative or less-invasive alternatives, informing shared decision-making
It can also identify previously unrecognized medical conditions (e.g., hypertension) that may warrant longer-term follow-up.

ASA Minimum Requirements

Per the ASA Guidelines for Preanesthesia Evaluation (2012), cited in Miller's, a pre-anesthesia evaluation must at minimum include:
  1. A patient interview — physical examination + review of medical, surgical, anesthetic, and medication history
  2. Diagnostic laboratory tests and other relevant diagnostic information
  3. An anesthesia plan

Benefits of Anesthesiologist-Led PAC

Compared to evaluations by surgeons or primary care physicians alone, anesthesiologist-led PAC is associated with:
  • More selective laboratory test ordering (reduced costs)
  • Reduced preoperative anxiety
  • Improved acceptance of regional anesthesia
  • Fewer day-of-surgery cancellations
  • Shorter hospital length of stay
  • Lower hospital costs

Evolution of PAC

Miller's notes that PAC has evolved from a "day before surgery" bedside visit into a comprehensive perioperative physician-led service, now integral to the Perioperative Surgical Home model — with anesthesiologists assuming leadership in assessment, optimization (prehabilitation, smoking cessation), and management of complex medical issues related to surgery.
— Miller's Anesthesia, 2-Volume Set, 10e, Chapter 28 (Pre-Anesthesia Evaluation), pp. 3822–3827
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