Pre-operative assessment

1. PRE-OPERATIVE ASSESSMENT
BY SARAH KHALID
DEPARTMENT OF ANESTHESIA

2. • It’s a process Of clinical assessment that Precedes the
delivery of anesthesia care for surgical and non surgical
procedure.
• It’s an opportunity to identify co-morbidities that may lead
to patient complications during the anesthetic, surgical,
or post-operative periods.

3. The guidelines of the American Society of Anesthesiologists (ASA) indicate that a
preanesthesia visit should definitely include the following:
# An interview with the patient or guardian to review medical, anesthesia, and
medication history
# An appropriate physical examination
# Review of diagnostic data (laboratory, electrocardiogram, radiographs,
consultations)
# Assignment of ASA physical status score (ASA-PS)

4. GOAL
1. To Evaluate the patient’s general health +Optimization if
necessary.
2. To anticipate possible difficulties + Planning to avoid them and
prepare .

5. OBJECTIVES
• Doctor patient relationship.
• Patient data.
• Anesthetic plan.
• Patient consent.

6. MEDICAL HISTORY
• Personal data : name, age, sex
• Review the file: preoperative diagnosis, planned surgery, Type of anaesthesia.
• Drugs history: allergy, current meds, reguler meds, anticoagulants.
• Past medical history : exercise tolerance, HTN, DM, COPD, CAD, thyroid
disease..
• Past surgical history : what, when and what type of anaesthesia.
• Past anesthetic history : PONV, anesthesia awareness.

7. • Social habits: smoking, alcohol and drug abuse.
• In lady patient : menstrual history ; pregnancy, LMP..
• In pediatric patient : postnatal period, congenital disease, vaccination.
• Last intake.
• Systemic review:
Respiratory ; cough, cold, SOB
Cardiac; palpitation, syncopal attacks, LL swelling
CNS
GIT oral cavity; dentures, loose and capped teeth.
genito urinary

8. AMPLE
A for allergies /anticoagulants.
M for medications (current and long term).
P for past medical, surgical and anesthetic history,
If pediatric patient : postnatal period, congenital disease, vaccination.
If lady : menstrual history, LMP.
L for last meal
E for events that occurred ending up with the patient to surgery / exercise
tolerance

9. EXAMINATION
• General examination : weight, BMI, vital signs, obvious facial, chest
and spine trauma or anomalies, oral cavity (teeth, tongue,
dentures).
• Systemic examination : chest, cardiovascular, CNS and regional
examination of the area of regional anesthesia.
• AIRWAY ASSESSMENT.

10. ANY QUESTIONS?!

11. NOT ALL AIRWAYS ARE CREATED EQUAL, THAT’S
OBVIOUS!!

15. RISK ASSESSMENT

16. • ASA does not include the nature of the procedure in predicting the
perioperative morbidity and mortality.
• It only include patient’s based morbidity rather than the type of
surgery.

18. PRE-OPERATIVE INVESTIGATIONS
• The nature of the exact investigations required depends on a
number of factors, including co-morbidities, age, and the nature of
the procedure.
• The urgency of the surgery will also dictate which conditions need
further investigation and management prior to surgery.
• Each specific hospital is likely to provide local guidelines, however
it is useful to understand the tests than could be done pre-
operatively and have an appreciation as to why each may be
requested.

19. BLOOD TESTS
• Full blood count
• Urea and electrolytes
• Liver function test
• Condition specific tests; HbA1c, thyroid function test.
• Clotting screen
• Blood group and cross match.

20. • Cardiac investigations : ECG, echo cardiography.
• Respiratory investigations : spiromety, plain Chest Xrays
• Others: urine analyses, Cardio pulmonary exercise testing.

22. SUMMARY
When approaching patient for the pre operating assessment:
• First introduce yourself.
• reassure the patient and comfort him, take history by AMPLE.
• second review his medical records and investigations.
• Third do physical examination starting by General look, vital signs
and systemic examination, then go to the airway assessment.
• don’t forget to take the patient’s consent.

23. ANY QUESTIONS?!

24. THANK U 🎉