• Pre-operative assessment has four goals:1.to acquire the relevant information about the
2.to educate the patient
3.to diminish anxiety
4.to obtain informed consent from the patient
for the proposed procedure.
• The assessment should determine:1. the nature and extent of the relevant surgical
2. the nature and extent of any disease which might
affect the conduct of the operation and
3. Any specific problems that might affect choice of
anaesthesia and postoperative care
• Present illness (including age, sex, complaint,
planned procedure, elective/ emergency?)
• Past Medical History:1.List of medical problems
2.Medications, allergies, drug history,
recreational drug use
3.Past surgeries, type of anesthetic used,
anesthetic related problems
• Family History:1.Any anesthetic related problems
• Social History:1.Smoking, alcohol, STDs, HIV etc
• Female:1. LMP, likelihood of current pregnancy
• Neurologic:1. seizure, stroke
• Haematologic:1. Anaemia, past transfusions
• Endocrine:1. Thyroid abnormalities, diabetes
• The most common general assessment of
fitness used by anaesthetists is the American
Society of Anesthesiologists' (ASA) .
A normal healthy patient
A patient with mild systemic disease
A patient with severe systemic disease
A patient with severe systemic disease that is a
constant threat to life
5. A moribund patient who is not expected to
survive without the operation (E)
6. A declared brain-dead patient whose organs are
being removed for donor purposes.
• A full blood count (FBC) is generally requested
to detect anaemia, which may place the
individual at risk from a general anaesthetic
• Coagulation profile if necessary
• All patients should have a dipstick urinalysis to
measure glucose, bilirubin, protein and
• In patients aged under 60 years, this is
• Serum sodium and potassium
• hyperkalaemia can predispose to cardiac
arrest, particularly if suxamethonium is given
• hypokalaemia can lead to cardiac arrhythmias.
• Urea and electrolytes are requested if :
1. Clinical evidence of renal disease.
2. Symptomatic cardiovascular disease.
4.Drugs-Diuretics, digoxin, steroids
• Liver function tests
1.Clinical evidence of liver disease.
2.Chronic liver disease, including a history of
Preoperative Chest X Ray
• to confirm or establish a diagnosis and
evaluate the extent of pathology
• to establish a baseline for comparison with
1. Cardiorespiratory disease.
2. Possible pulmonary malignancy (primary or
3. Severe trauma.
4. Immigrants from countries with endemic TB.
• Abnormalities are relatively common,
between 47% and 52% and correlate with
• only 1.6% of patients with abnormal
preoperative ECGs experience a perioperative
adverse cardiovascular event
• In only half of these the preoperative ECG
1. Patients older than 60 years undergoing
2. Symptoms and signs of cardiovascular
disease, including ischaemic heart disease or
3. Symptomatic respiratory disease.
• Difficult tracheal intubation accounts for 17%
of the respiratory related injuries and results
in significant morbidity and mortality.
• Up to 28% of all anaesthesia related deaths
are secondary to the inability to mask
ventilate or intubate
• A global assessment should include the
1.Patency of nares : masses inside nasal cavity
(e.g. polyps) deviated nasal septum, etc.
2.Mouth opening of at least 2 large finger
breadths between upper and lower incisors in
adults is desirable.
Preoperative fasting guidelines
The volume of liquid ingested is less important than the type of liquid
Intake of water up to 2 hrs before induction of anaesthesia.
Other clear fluids *, clear tea and coffee without milk up to 2 hrs before
induction of anaesthesia.
Tea and coffee with milk are acceptable up to 6 hrs before induction of
The volume of administered fluids does not appear to have an impact on
patient’s residual gastric volume and gastric pH, when compared to a
standard fasting regimen.
Therefore, patients may have unlimited amounts of water and other clear
fluid up to two hours before induction of anaesthesia.
The intake of solid foods
A minimum pre-op fasting time of 6hrs is
recommended for food (solids and milk).
Fried or fatty meal 8hrs is recommended before
induction of anaesthesia.
Chewing gum and sweets
Chewing gum should not be permitted on the day of
Sweets are solid food. A minimum of 6hrs pre-op
fasting time is recommended.
• Higher-risk patients should follow the same pre
op fasting regime as healthy adults, unless
• Adults undergoing emergency surgery should be
treated as if they have a full stomach.
• If possible, the patient should follow normal
fasting guidance to allow gastric emptying.
• High risk of regurgitation and aspiration; patients
include those with obesity, gastro-oesophageal
reflux and diabetes.