Preoperative Evaluation and

choice of Anesthetic Technique

Preoperative evaluation and preparation for

anesthesia begins when the anesthesiologist
reviews the patient’s medical record and visits
the patient the day before elective surgery
Important aspects of the
preoperative evaluation include:
• History
• Review of current drug therapy
• Physical examination
• Interpretation of laboratory data
• Consent
• Planned management of anesthesia
• Methods available for relief of post operative pain
• Fasting
• Assignment the physical status classification
• Premedication
History
• Previous adverse responses related to anesthesia
2. Allergic reactions
3. Prolonged skeletal muscle paralysis
4. Delayed awakening
5. Nausea and vomiting
6. Hoarseness
7. Myalgia
8. Hemorrhage
9. Jaundice
10. Post spinal headache
11. Adverse responses in relatives
• Central nervous system
2. Cerebrovascular insufficiency
3. Seizures

• Cardiovascular system
6. Exercise tolerance
7. Angina pectoris
8. Prior myocardial infarction
9. Hypertension
10. Rheumatic fever
11. Claudication
12. dysrhythmias
• Lungs
2. Exercise tolerance
3. Dyspnea and orthopnea
4. Cough and sputum production
5. Bronchial asthma
6. Cigarette consumption
7. Pneumonia
8. Recent upper respiratory tract infection
• Liver
2. Ethanol consumption
3. Hepatitis

• Kidneys
6. Nocturia
7. Pyuria

• Skeletal and muscular systems

10. Arthritis
11. Osteoporosis
12. Weakness
• Endocrine system
2. Diabetes mellitus
3. Thyroid gland dysfunction
4. Adrenal gland dysfunction

• Coagulation
8. Bleeding tendency
9. Easy bruising
10. Hereditary coagulopathies
• Reproductive system
2. Menstrual history
3. Sexually transmitted diseases

• Dentition
7. Dentures
8. Caps
Drug usage and potential interactions with
drugs administered in the Perioperative
period

Alcohol abuse • tolerance to anesthetic

drugs

Antibiotics • Prolongation of muscle

relaxants

• Impaired sympathetic
Antihypertensive nervous system
responses
Aspirin • Bleeding tendency

Benzodiazepines • Tolerance to
anesthetic drugs

Beta antagonists • Bradycardia

• Bronchospasm
• Impaired sympathetic
nervous system
responses
• Myocardial
depression
Calcium channel blockers • Hypotension

Digitalis • Cardiac dysrhythmias or

conduction disturbances

Diuretics • Hypokalemia,
Hypovolemia
• Exaggerated response to
Monoamine oxidase
sympathomimetic drugs
inhibitors
with acute treatment

• Exaggerated response to
Tricyclic antidepressants sympathomimetic drugs
with acute treatment
Physical examination
• Central nervous system
1. Level of consciousness
2. Evidence of peripheral sensory or skeletal
muscle dysfunction
• Cardiovascular system

3. Auscultation of the heart (heart rate, rhythm,

murmur)
4. Blood pressure (supine and standing )
5. Peripheral pulses (arterial cannulation site)
6. Veins (access site)
7. Peripheral edema
• Lungs
2. Auscultation of the lungs (rales, wheezes)
3. Pattern of breathing
4. Anatomy of thorax (emphysema)
• Upper airway
2. Cervical spine mobility
3. Temporomandibular mobility
4. Prominent central incisors
5. Diseased or artificial teeth
6. Ability to visualize uvula
7. Thyromental distance
• Coagulation
Bruising
Petechiae

Thank you