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Anaesthetic Preoperative Assessment. A powerpoint presentation.
- 1. 1 PREANAESTHETIC REVIEW BY DR. AHMADZUBAIR DEPARTMENT OF ANAESTHESIA AND INTENSIVE CARE. AMINU KANO TEACHING HOSPITAL 26th SEPTEMBER, 2025 9/26/2025
- 2. 2 OUTLINE • Introduction • Aims •General Principles • Pre-Operative History and Examination • Pre-Operative Investigations • Anaesthetic Risk Assessment(ASA Classification) • Plan • Conclusion 9/19/2025
- 3. 3 INTRODUCTION • The pre-operativevisit to all patients by an anaesthetist is an essential requirement for the safe and successful conduct of anaesthesia. • Pre-operative assessment is defined as the process of clinical evaluation that precedes the delivery of anaesthesia for surgical and non-surgical procedures. • It entails obtaining information and identifying risks with the aim of reducing morbidity and mortality associated with anaesthesia and surgery. 9/19/2025
- 4. 4 AIMS OF PRE-OPERATIVEASSESSMENT • To develop rapport with the patient so as to allay anxiety and facilitate conduct of anaesthesia. • To evaluate the patient’s medical condition. • To optimize the patient’s medical condition for anaesthesia and surgery. • To determine risk factors for anaesthesia. • Inform and educate the patient about anaesthesia, peri-operative care and pain management. • To obtain informed consent for anaesthesia. • To plan anaesthetic technique and perioperative care. 9/19/2025
- 5. 5 GENERAL PRINCIPLES • Personnel:performed preferably by the anaesthetist conducting the anaesthesia. • Timing: appropriate time before scheduled surgery to allow adequate patient preparation. • Venue: as in-patients, out-patients, or at a pre-anaesthetic clinic. • Admissions: Pre-operative admissions for major surgeries or those with co-morbidities. • Conduct: Personal interviews, questionnaires, pre-op information pamphlets. 9/19/2025
- 6. 6 PRE-OPERATIVE HISTORY TAKING •Biodata • Presenting complaint • History of presenting complaint • Systemic review: most emphasis on CVS and Respiratory systems a)CVS: chest pain, palpitations, dyspnea, orthopnea,PND b)Respiratory system: cough +- fever, cold/catarrh,DIB,OSA, • Type of surgical procedure. • Past medical history: r/o comorbidities like diabetes, hypertension, epilepsy, renal failure, Asthma, neuromuscular disease. 9/19/2025
- 7. 7 PRE-OPERATIVE HISTORY TAKING •Previous surgical and anaesthetic history: difficult airway, unplanned ICU admission, delayed recovery, difficult IV access, PONV, Anaphylaxis, previous transfusion (rxns) • Drug history / history of allergies: prescribed and unprescribed drugs. • Family history: history of problems with anaesthesia, unexplained deaths, malignant hyperthermia. • Social history; support system, smoking, alchohol consumption, attitude towards transfusion 9/19/2025
- 8. 8 PHYSICAL EXAMINATION • Generalphysical examination; general constitution, weight, pallor, icterus ,cyanosis, hydration status, • Systemic exam: emphasis on a)Cardiovascular System : Pulse rate, Blood pressure, Jugular venous pressure, cardiac sounds b)Respiratory System:, Respiratory rate, lung expansion, breath/lung sounds, Oxygen saturation • Special examination: Airway assessment peripheral venous access Spinal examination 9/19/2025
- 9. 9 AIRWAY ASSESSMENT • Aimis to try and predict those patients in whom there may be difficulty with intubation. • Assessment is made in three stages: a. Observation of patient’s anatomy: mouth opening, mandible, teeth, tongue, soft tissue swellings, cervical spine. b. Simple bedside tests: Wilson’s score, Mallampati’s criteria, thyromental distance, Cormack and Lehane classification of glottic visualization. c. X-rays: Lateral x-rays of head and neck. 9/19/2025
- 10. 10 WILSON’S RISK SCORE Riskfactor Level Score Weight <90kg 90 - 110kg >110kg 0 1 2 Head and neck movement Above 90 ° About 90° Below 90° 0 1 2 Jaw movement IG>5cm or SL>0 IG<5cm & SL=0 IG<5cm and SL<0 0 1 2 Receding mandible Normal Moderate Severe 0 1 2 Buck teeth Normal Moderate Severe 0 1 2 IG =Inter incisor gap measured with mouth fully open SL = Subluxation: Maximal forward protrusion of the lower incisors beyond upper incisors Score 5 or < = easy laryngoscopy Score 8-10 = Severe difficulty in laryngoscopy. 9/19/2025
- 11. 11 MALLAMPATI CLASSIFICATION –(P-U-S-H) 9/19/2025
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- 14. 14 LEMON SCORING EVALUATION CRITERIAPOINTS L=LOOK EXTERNALLY Facial trauma large incisors beard or moustache Large tongue 1 1 1 1 E=EVALUATE THE 3-3-2 RULE Incisor distance <3 fingerbreadths Hyoid-Mental distance <3 fingerbreadths Thyroid to hyoid distance <2 finger breadths 1 1 1 M=MALLAMPATI (SCORE >3) 1 O=OBSTRUCTION( E.G EPIGLOTITIS, PERI TONSILLAR ABCESS) 1 N= NECK MOBILITY (LIMITED MOBILITY) 1 TOTAL POINTS 10 9/19/2025
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- 16. 16 INVESTIGATIONS • FBC: Anaemia,Infections , Platelet count • U/E/CR: Diabetes, renal disease, vomiting / diarrhea, Drugs • LFT; Hepatic Disease, Alcoholics, metastatic dx • Blood sugar: Diabetes, long term steroid use • ECG: Hypertensives, Features of heart disease,elderly • CXR: Cardiac or respiratory disease, malignancies, planned thoracic surgery,elderly • Coagulation screen: bleeding diasthesis, Patients on anticoagulants • Cervical spine x-ray: Rheumatoid Arthritis, Neck trauma • Blood grouping and saving or cross matching 9/19/2025
- 17. 17 ANAESTHETIC RISK ASSESSMENT •Anaesthetists assess risks of anaesthesia (and surgery). • Incidence of primary anaesthetic mortality in the UK CEPOD study was 1:185000 operations. • Leading cause of death after surgery is myocardial infarction. • Factors associated with high risk of mortality include: Age >60, male sex, worsening physical status, comorbidities, complexity of surgery, length of surgery, and emergency operations. 9/19/2025
- 18. 18 • Of thesefactors, physical status has proved to be a powerful predictor of post-op morbidity and mortality. • The most common method of categorizing patients is by using the American Society of Anaesthesiologists physical status scale. 9/19/2025 ANAESTHETIC RISK ASSESSMENT
- 19. 19 ANAESTHETIC RISK ASSESSMENT •Based on the preoperative assessment, the patients are classified into six categories by American Society of Anesthesiologist (ASA) physical status scale. • The morbidity and mortality is highest in grade V patients and minimum in grade I patients. Emergency Operation E: Any patient in whom emergency operation is required. The suffix ‘E’ is added. 9/19/2025
- 20. 20 ASA PHYSICAL STATUSSCALE 9/19/2025
- 21. 21 PLAN • Type ofanaesthesia to be used. a) General- Airway management, induction, maintenance , monitoring, emergence. b) Regional: Technique, agents to be used. c) Sedation and Monitored Anaesthetic Care. • Intra-op issues: monitors, positioning, fluid management, site concerns. • Post-op issues: Acute pain management, PONV,need for intensive care , hemodynamic monitoring. 9/19/2025
- 22. 22 INFORMING THE PATIENT •In order to allow the patient to make an informed decision, sufficient information should be provided during the pre-op visit . This includes: a) The planned anaesthetic technique. b) Alternative anaesthetic options if applicable. c) Possible risks and complications pertaining to anaesthesia • Patients and next of kin should be counselled especially those with comorbidities, high risk patients. • Consent should be obtained. • Instructions should be given e.g. fasting, medications, e.t.c. 9/19/2025
- 23. 23 ASA FASTING GUIDELINES Ingestedmaterial Minimum fast Clear liquids 2h Breast milk 4h Infant formula milk 4-6h Non human milk 6h Light meal 6h Heavy meal 8h 9/19/2025
- 24. 24 Instructions Related toModification in Pre-existing Medical Therapy • Oral hypoglycaemics • Antibiotics • Anticoagulants • Anti hypertensives • Antidepressants • Oral contraceptives • Anticholinesterases • Steroids • Smoking • Insulin • Herbal Medicines • Diuretics • Antitubercular Drug • Anticonvulsants 9/19/2025
- 25. 25 CONCLUSION • The pre-operativevisit to all patients is the Responsibility of the anaesthetist and is an integral part of safe anaesthetic practice. • It’s established that a pre-operative visit from the anaesthetist resulted in greater reduction in patient anxiety than preoperative sedative drugs. • Inadequate preoperative planning and incomplete patient preparation are commonly associated with anesthetic complications. 9/19/2025
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- 27. 27 REFERENCES • Oxford handbook for Anaesthesia • Lee C.Y, Lim F. Recommendations on Preanaesthetic assessment. • Ajay Yadar, Short Text book of Anaesthesia, 6th edition. • . Miller's Anaesthesia Basics • Morgan & Mikhail’s Clinical Anaesthesiology. 9/19/2025