This document discusses the process of preanesthesia evaluation to assess patient risk and optimize their health prior to surgery or other procedures requiring anesthesia. Key aspects of the evaluation include obtaining a medical history and physical exam, assessing functional status, identifying high-risk factors, reviewing medications, and addressing modifiable risks in order to reduce complications and costs of care. The goal is to choose an anesthesia plan guided by patient choice and medical risks.

2.  History and physical examination to determine relevant tests
and consultations
 Guided by patient choice and medical risk factors choose a
plan of care
 Informed consent
 Educate patient about anaesthesia, pain management and
perioperative care
 Reduce patient care costs

3. What is the risk of proceeding versus the
benefit to the patient?
Can we modify these risks before
surgery?

4.  Preanesthesia evaluation: process of assessment and
optimization of patient proceeding delivery of anesthesia
carefor surgery and for non surgical procedures.

15. Best done by an anaesthetist
Certain features of concern
 small mouth
 poor dentition
 limited neck mobility
 scars/surgery/anatomical abnormalities
 obesity

53.  Approx 1:26,000 anaesthetics
 One third of deaths are preventable
 Causes in order of frequency
 inadequate patient preparation
 inadequate postoperative management
 wrong choice of anaesthetic technique
 inadequate crisis management

54. Risk factor Criteria
High-risk surgery AAA repair, thoracic, abdominal surgery
IHD MI, Q on ECG, angina, nitrates, EST+
CCF History, examination, CXR
Cerebrovascular disease Stroke, TIA
Diabetes Insulin treatment
Renal impairment Creatinine >177 mol/L
Number of factors % population Major cardiac complications
0 36% 0.5%
1 39% 1%
2 18% 5%
3 7% 10%
4 15%
5 30%

55. 1 MET Can you dress yourself?
4 MET Can you climb a flight of
stairs?
10 MET Can you participate in
strenuous activities (swimming,
tennis,football)

56. All patients for major surgery should have METs > 4
Duke Activity Index
1 MET Can you take care of yourself? 4 METs Climb a flight of stairs or walk up a hill?
Eat, dress, or use the toilet? Walk on level ground at 4 mph or 6.4 km/h?
Walk indoors around the house? Run a short distance?
Walk a block or two on level ground
at 2 to 3 mph or 3.2 to 4.8 km per h? Do heavy work around the house like scrubbing
floors or lifting or moving heavy furniture?
Do light work around the house like
4 METs dusting or washing dishes? Participate in moderate recreational activities
like golf, bowling, dancing, doubles tennis, or
throwing a baseball or football?
>10 METs Participate in strenuous sports like swimming,
singles tennis, football, basketball, or skiing?

57.  Family history
 Previous anaesthetics
 PONV
 allergy
 malignant hyperpyrexia
 difficult airway
 difficult IV access

58. Very useful, often forgotten
 Current medications
 ALLERGY
 Medic alert bracelets
 Smoking/alcohol history
 Other drugs of abuse!

59.  Take all usual medications
 Antihypertensives
 Beta blockers
 Statins
 Think about discontinuing/replacing
 Aspirin
 Anticoagulants
 Diabetic medications
 MAOIs

60.  History and physical most important assessors of
disease and risk
 ASA and functional status good predictors of risk
 Lab tests have some usefulness
 add little in low risk patients
 may add false + ves
 add expense