General Preoperative Assessment

Introduction

The preoperative assessment is the first step in providing effective anesthesia for a patient. It is a process by which the anesthesia provider intentionally evaluates their patient and creates a plan to safely conduct anesthetic care. As many surgeries are becoming outpatient cases, the preoperative assessment is often done on the day of surgery, however, depending on the patient and their comorbidities, the nature of the surgery, and the institution providing care, this assessment can also be done further in advance in a preoperative clinic setting. The major goals of the preoperative assessment are to build rapport with the patient and their support person(s), ensure the patient is medically fit for surgery, perform a physical exam including airway exam, educate on the risks and benefits of the anesthetic plan, determine the need for any special monitors, lab work or medications, and obtain informed consent.

Chart Review

History and Physical

Obtaining a focused yet thorough patient history is a hallmark of the preoperative assessment. History often includes:

1. Medical history and comorbidities (include gestational age, complications at birth/NICU admission)
2. Family history of complications with anesthetics (i.e. malignant hyperthermia, pseudocholinesterase deficiency)
3. Indications for the surgery
4. NPO status
5. History of previous anesthetics and any known complications (i.e. difficult airway, PONV, intraoperative complications)
6. History of current/recent upper respiratory tract infections
7. Any known allergies
8. Medications
9. Review of systems

Medical History - obvious reasons

Family History - important to ask as many first anesthetic for most

Indication for surgery - positioning

NPO status - insert NPO time table. important for decreasing aspiration risk

Prev anes- guide your current plan

URI - case cancellation, laryngospasm risk

Allergies- to medications, foods, environmental factors.

Meds - drug interactions

ROS - insert another table

Pre-operative Labs

1. Hemoglobin/hematocrit/platelets
2. Electrolytes
3. Liver function
4. Coagulation
5. Specifically indicated

Pre-operative Imaging

1. Chest x-ray
2. CT scan
3. MRI

Discussion with Surgeon/Procedurist

Discussion with patient/parent [guardiab]

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Relevant Article Depot:

Preoperative anesthesia evaluation

Statement on ASA Physical Status Classification System

Paediatric emergencies

One Size Does Not Fit All: A Perspective on the American Society of Anesthesiologists Physical Status Classification for Pediatric Patients

The Pediatric-Specific American Society of Anesthesiologists Physical Status Score: A Multicenter Study

Age, ASA physical status and surgical outcomes: insights from a nationwide cohort study

Assessment of Gastric Content Using Gastric Ultrasound in Patients on Glucagon-Like Peptide-1 Receptor Agonists Before Anesthesia

ASA physical status classification: a relic of a bygone time?

Enhancing Anesthetic Preoptimization: Promising Opportunities for Innovation in Economically Diverse Regions

American Society of Anesthesiologists Statement on ASA Physical Status Classification System