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Principles/History of GAPS

One of the most important elements of anesthesiology practice is the preoperative assessment and preparation of patients for anesthesia and surgery. A pre-anesthetic evaluation is considered a basic element of anesthesia care. Cardiovascular disease remains the most common major medical problem encountered in the Perioperative period in the U.S.A and other developed countries. Of the 27 million patients that undergo surgery in this country, approximately 8 million are estimated to have either documented coronary artery disease or at least one risk factor for cardiovascular disease. This problem is further exacerbated by the increasing age of the population, making cardiovascular disease one of the most important public health related issues faced by the medical community.

It is no surprise that algorithms have been developed to help in the evaluation of patients undergoing elective and emergent surgical procedures. One of the most widely known and widely used algorithm is published periodically by the American College of Cardiology–American Heart Association Task force on Perioperative Cardiovascular Evaluation for Non-cardiac Surgery. The AHA in an effort to aid practitioners, distributed cards and posters -with the step wise approach- so people in charge of perioperative evaluation could have a handy piece of paper and point of reference close by, when dealing with the evaluation of patients undergoing non-cardiac surgery.

My interest was to change this method of education in to a more sophisticated, electronic, interactive, point of care, user friendly system that could include the proposed guidelines and algorithm. PDA’s have been used in virtually every medical field. Advances in computer technology have made them almost essential in current medical practice. By 2005, it is estimated that at least 50% of US physicians will use personal digital assistants. Their portability, multifunctional capabilities and their relative ease of use make them an attractive alternative for point-of-care clinical reference and patient management devices.

Thanks to an educational grant by the University of Florida and COMEC, today I bring you G.A.P.S (Gainesville, Anesthesiology PDA, software program) a project that thanks to my awesome (and patient) team has been in the making since September 2003. We have incorporated the proposed stepwise strategy for preoperative evaluation for non cardiac surgery into electronic PDA/web interactive format, that provides the user with a portable, point-of-care, handheld tool for perioperative evaluation of patients with, or at risk for, cardiovascular disease. Our initial goal was to incorporate the algorithmic approach and then learn and grow from there. But my teammates accepted my "requests" and we decided to include other pieces of information relevant to anesthesiologists. I want to sincerely thank not just my team but the many people that one way or another helped get GAPS going (MEM, HVO) my most sincere gratitude. We hope you enjoy using this tool.

Dr. Felipe Urdaneta, M.D.