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Preanesthesia evaluation (pac)
- 1. Preanesthesia evaluation (PAC) PRESENTEDBY Dr. ATTINDER PAL SINGH MENTOR - Dr. ARVIND ARYA SIR H.O.D. DEPARTMENT OF NEUROANESTHESIA (IHBAS)
- 2. WHAT IS IT? • Its a process of clinical assessment that precede the delivery of anesthesia care for surgery and for non surgical procedure (e.g.MECT). • clinical foundation for guiding perioperative patient management
- 3. OBJECTIVES • discovery oridentification of a disease or disorder that may affect perioperative anesthetic care • verification or assessment of an already known disease, disorder, medical or alternative therapy that may affect perioperative anesthetic care • formulation of specific plans and alternatives for perioperative anesthetic care. • Inform and educate the patient about anaesthesia, perioperative care and pain management • Obtain informed consent for anaesthesia
- 4. Components • Preanesthetic history •General Physical examination • Systemic examination • Airway examination • investigations
- 5. HISTORY TAKING • demographicdetails • presenting complaints • previous medical history and comorbidities • previous surgical and anesthetic exposure • previous history of difficult airway, drug allergies and postop icu stay • personal history • drug and family history
- 6. GENERAL PHYSICAL EXAMINATION •look for pallor ,icterus, clubbing,cyanosis,pedal edema and lymphadenopathy • weight and height measurement • Preoperative Hemodynamic parameters NIBP, PR, RR & TEMP.
- 7. SYSTEMIC EXAMINATION • respiratorysystem • cardiovascular system • cental nervous system • GI examination • special focus : airway examination, spine examination & peripheral venous access
- 8. AIRWAY EXAMINATION • mouthopening (interincisors distance more than 4.5cm roughly 3 fingers ) • dentition and tongue • mallampati grading • thyromental distance 6.5cm • sternomental distance 12.5 • temparomandibular joint mobility • cervical joint movements • position of trachea
- 9.
- 10. RESPIRATORY EXAMINATION • Inspection• Rate & Rhythm , chest expansion ,symmetry of chest expansion , movements of the chest wall presence of intercostal recessions or the use of accessory muscles • Palpation Position of the Apex beat and Trachea • Percussion • Auscultation Breath sounds
- 11. CARDIOVASCULAR EXAMINATION • INSPECTION:apex beat , chest shape, abnornmal vessels ,any lumps,or previous scars • PALPATION: confirm apex beat, all peripheral pulses,presences of any thrills • PERCUSSION: heart borders • AUSCULTATION: S1 , S2 & murmurs.
- 12. American Society ofAnesthesiologists Classification
- 13. INVESTIGATIONS Blood Tests • HemoglobinHematocrit Complete blood count Coagulation studies Serum chemistries (i.e., sodium, potassium, glucose) Potassium Glucose Urinalysis (as distinct from pregnancy testing) Pregnancy evaluation Cardiac Evaluation • Electrocardiogram • Other cardiac evaluation (e.g., angiography, echocardiography, stress tests) Cardiac function tests Echocardiography (transesophageal, transthoracic) Stress tests Ventriculography Pulmonary Evaluation • Chest radiography • Other pulmonary evaluation (e.g.,pulmonary function tests,spirometry)
- 15. DRUGS TO BEDISCONTINUED • Antihypertensives: continue except ACE inhibitors and ARBs • Oral hypogycemics :skip morning dose • Thyroid :continue on the day of surgery • Heparin : 6to8hrs • Clopidogrel : 5days • Anticonvulsants : continued
- 16. INFORMED CONSENT • forprotecting the legal rights of patients and guiding the ethical practice of medicine • We inform the patient / gaurdian about the procedure,type of anesthesia to be given and complications involved .