This document provides guidelines for pre-operative assessment of surgical patients. The goals of assessment are to obtain relevant patient information, educate the patient, reduce anxiety, and obtain informed consent. The assessment should determine the nature of the surgical pathology and any medical conditions that could impact the operation or recovery. It involves taking a thorough history, conducting a medical review of all body systems, and classifying patients based on their overall health using the American Society of Anesthesiologists scale. Recommended pre-operative tests include blood tests, urine analysis, EKG, chest x-ray and airway examination. Fasting guidelines state that clear fluids can be consumed up to 2 hours before surgery while solid foods should be avoided for at least 6

1. ‫بسم ال الرحمن الرحمن‬

2. Pre-Operative Assessment Of
Surgical Patients

3. • Pre-operative assessment has four goals:1.to acquire the relevant information about the
patient's state
2.to educate the patient
3.to diminish anxiety
4.to obtain informed consent from the patient
for the proposed procedure.

4. • The assessment should determine:1. the nature and extent of the relevant surgical
pathology
2. the nature and extent of any disease which might
affect the conduct of the operation and
postoperative course
3. Any specific problems that might affect choice of
anaesthesia and postoperative care

5. History
• 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

6. • Family History:1.Any anesthetic related problems
• Social History:1.Smoking, alcohol, STDs, HIV etc

7. Systemmic Review
• General:1.Vital signs
2.Exercise tolerance, weakness, fatigue, fever,
weight changes, frequent headaches
• Skin:1.Rashes, sores, lesions
• Eyes:1.Double vision, blurring, glaucoma, cataract

8. Ear:•Vertigo, discharge
Mouth:•Bleeding gums, dentures, loose teeth
Cardiovascular system:•MI , CCF , murmurs, angina, palpitations
•peripheral oedema

9. • Respiratory system:1.Cough, sputum, haemoptysis, asthma, TB
• GI:1.Hiatus hernia, GERD, diarrhoea, constipation,
haematemesis, maleana, jaundice, hepatitis
• Urinary system:1.Frequency, urgency, nocturia, dysuria,
haematuria, incontinence

10. • Female:1. LMP, likelihood of current pregnancy
• Neurologic:1. seizure, stroke
• Haematologic:1. Anaemia, past transfusions
• Endocrine:1. Thyroid abnormalities, diabetes

11. • The most common general assessment of
fitness used by anaesthetists is the American
Society of Anesthesiologists' (ASA) .

12. ASA Classification
1.
2.
3.
4.
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.

13. Investigations

14. • 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

15. Biochemistry
• All patients should have a dipstick urinalysis to
measure glucose, bilirubin, protein and
ketones.
• In patients aged under 60 years, this is
sufficient

16. • Serum sodium and potassium
• hyperkalaemia can predispose to cardiac
arrest, particularly if suxamethonium is given
• hypokalaemia can lead to cardiac arrhythmias.

17. • Urea and electrolytes are requested if :
1. Clinical evidence of renal disease.
2. Symptomatic cardiovascular disease.
3.Diabetes.
4.Drugs-Diuretics, digoxin, steroids

18. • Liver function tests
1.Clinical evidence of liver disease.
2.Chronic liver disease, including a history of
hepatitis.

19. Preoperative Chest X Ray
• to confirm or establish a diagnosis and
evaluate the extent of pathology
• to establish a baseline for comparison with
postoperative films

20. 1. Cardiorespiratory disease.
2. Possible pulmonary malignancy (primary or
secondary).
3. Severe trauma.
4. Immigrants from countries with endemic TB.

21. ECG
• Abnormalities are relatively common,
between 47% and 52% and correlate with
increasing age.
• only 1.6% of patients with abnormal
preoperative ECGs experience a perioperative
adverse cardiovascular event
• In only half of these the preoperative ECG
was helpful.

22. 1. Patients older than 60 years undergoing
major surgery.
2. Symptoms and signs of cardiovascular
disease, including ischaemic heart disease or
hypertension.
3. Symptomatic respiratory disease.

23. Airway Assessment

24. • 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

25. • A global assessment should include the
following:
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.

26. Preoperative Fasting Guidelines

27. Preoperative fasting guidelines
 The volume of liquid ingested is less important than the type of liquid
ingested.
 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
anaesthesia.
 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.

28.  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
surgery.
 Sweets are solid food. A minimum of 6hrs pre-op
fasting time is recommended.

29. • Higher-risk patients should follow the same pre
op fasting regime as healthy adults, unless
contraindicated.
• 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.

30. THANK YOU FOR YOUR ATTENTION