pre anesthesia check up before conducting any anesthesia is very importent

1. Pre-anaesthesia check up
and Consent

2. Pre-anaesthesia check up (PAC)
• Defined as the process of clinical assessment that precedes the delivery of
anesthesia for surgical and nonsurgical procedures.
• Assess, known and diagnose unknown co-morbidities which directly or
indirectly affect the perioperative management of the patients.
• Adequate foresight in this regard helps make specific plans and alterations
in inpatient management in order to make surgery safer.
• The PAC also helps in risk stratification and provides an opportunity to
achieve optimum preoperative optimization.

3. PAC…….. Why do it??
• Helps make specific plans and alterations in inpatient management.
• Risk stratification and allows preoperative optimization.
• Reduces perioperative morbidity and mortality.
• Reduces the need for unnecessary investigations and consultations.
• Reduction in case cancellations and delays as well as a reduction in
the length of hospital stay.

4. PAC - constituents
• Patient's history,
• Physical examination, and
• Review of pertinent medical records when available.
• Review of current medications.
• Detection of any abnormality then warrants investigations or
consultations with relevant specialties.

6. Pre-operative investigations…..Routine
testing??
• The ASA practice advisory defines a routine test done in the PAC
setting as one done without a specific indication that may have been
obtained on history or physical examination.
• Routine testing has not only found to be of little benefit but there
also seems to be majority consensus among ASA members against
its use.
• The advisory also goes on to suggest that every time a test is
ordered the reason/indication for the test should be documented.

7. Pre-operative investigations
• The NICE guidance for pre-operative testing suggests that no routine
testing is advisable in ASA class I and II patients for minor and
intermediate-grade surgeries.
• Even for complex major surgeries, they advise a cautious approach
with not all tests to be ordered routinely in these groups.
• Dearth of data delineating the practice of ordering preoperative tests
for patients undergoing routine elective surgery in India.
• Substantial variations found in the practice which vary markedly from
one hospital to another and even among clinicians of the same
hospital.[6]

9. Consent
• Implied or Implicit
• Explicit verbal/written/video recording

10. Hunter vs Hanley, 1955
• Hanley was injured when the needle used to administer an injection by
Dr Hunter broke in situ. She alleged negligence as the needle used was
not appropriate for the purpose. The Scottish courts found that to prove
negligence, it must be established that no professional of ordinary skill
would have taken that course of action if acting with ordinary skill and
care.3 This is the precursor to the Bolam principle, and remains the
standard for medical negligence in Scots Law.