Preoperative Evaluation




Purpose



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  • Establish relationship
  • Familiarize self with patient, their medical problems and need for further evaluation, and the planned surgical procedure
  • Assess anesthetic risk and develop perioperative plan (preoperative medications, intraoperative management, postoperative care)
  • Discuss pertinent anesthetic risks, answer questions, and obtain informed consent
  • Document the above




Should be done as early as possible before the day of surgery for high-risk patients.




Institutional differences in requirements and role of preoperative anesthesia evaluation clinics.




History



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  • Past medical history:

    • Disease processes, symptoms, treatment, severity
    • Degree of optimization
    • Need for further consultation/testing
    • ASA classification correlates well with outcomes

  • Past surgical history
  • Past anesthetic history: general, MAC, spinal, epidural, peripheral nerve blocks
  • Past history of anesthetic complications: allergic reactions, severe postoperative nausea and vomiting, delayed awakening, prolonged paralysis, neuropathy, intraoperative awareness, hoarseness, difficult intubation, postdural puncture headache
  • Family history of anesthetic complications: malignant hyperthermia, prolonged paralysis
  • Current medications:

    • Updated list and what patient took/to take day of surgery
    • Implications regarding intraoperative hemodynamics, drug interactions, tolerance to anesthetic drugs, bleeding tendencies, electrolyte abnormalities
    • See below for role of beta-blockers
    • Herbs or supplements, while not considered medications, can have significant side effects or drug interactions and the patient must be asked about their use (see Chapter 10)

  • Allergies:

    • Allergy versus adverse effects
    • Medications, latex (associated risk factors: see Chapter 35), adhesives, egg, soy




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ASA Physical Status Classification System






















I Normal, healthy patient
II Mild systemic disease without functional limitations
III Systemic disease with functional limitations
IV Severe systemic disease that is constant threat to life
V Moribund patient who will not survive without surgery
VI Brain-dead patient for organ retrieval
E All emergency procedures


Jun 27, 2019 | Posted by in ANESTHESIA | Comments Off on Preoperative Evaluation
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