Overall aims of Pre-Op Assessment

:
Realistic benefits >< risks of surgery
Anticipate potential problems
Ensure the patient is prepared
Information and consent to patient
Premedication and/or prophylactic

PREOPERATIVE ASSESSMENT
PROBLEMS
MECHANISM
ASA I
Normally healthy individuals
Anamnesis
- Current condition Systemic effect, potential effects on
perioperative management e.g CVS
disturbance, severe anemia, nutritional
status
- Anaesthetic/Surgery
History
to anticipate & encounter problems e.g
problems in intubation, side effects of
drugs, .?

pre-op assesment (Contd.)

PROBLEMS
- Drug history

Medical history

Allergic History

MECHANISM
Drug interaction during anaesthesia,
dose adjusment e.g antidepressant
agents, antidiabetics, diuretics, MAOI,
antihypertensive agents
to anticipate problems, esp. CVS and
respiratory problems and previous
illness during anaesthesia e.g Asthma,
bronchitis, TB, angina/MI episodes,
CHF history, Diabetes Mellitus
to anticipate and distinguish true allergy
and adverse reaction e.g anaesthetic
drugs, hyperactivity of vasoactive drugs
in atopic individuals

pre-op assessment (contd.)

PROBLEMS
- Smoking

MECHANISM
Frequency, amount and type of
cigarettes (pack per day) anticipate
side effects e.g vascular disease,
coronary & cerebral circulations,
chronic bronchitis

- sympathetic action by nicotine tachycardia,

hypertension
- Carboxyhemoglobin >>> causing reduction in
available oxygen
- Hyperactivity of mucous production

pre-op assessment (contd.)

PROBLEMS

MECHANISM

Alcohol

Frequency, amount and type of

liquor organ damage hepatotoxic,
cardiomyopathy, gastritis, pancreatitis
adverse reaction on drugs, increase
risk, dose tolerance esp. on
barbiturates

Family history

hemoglobinopathies, blood dyscracia,

hemostatic problems

pre-op assessment (contd.)

PROBLEMS

MECHANISM

Physical diagnostic
- General app.
Nutrition status, anemic, anxiety,
conciousness, etc effecting the type of
anaesthesia technique used in the
procedures, and dose adjusment, and
also to anticipate the possible risk
- CVS signs
Cough, thick sputum, dyspneu
causing the risk of respiratory
problem
during surgery

pre-op assessment (contd.)

PROBLEM
-

Airway manag.

MECHANISM
To anticipate problems during surgery

- prosthetic teeth, protruding/loose teeth

- short neck mental-hyoid < 5cm
- Mallampati test :
Class I
: pharyngeal pillars, soft palate, uvula
Class II
: soft palate, uvula
Class III
: soft palate
Class IV
: soft palate not visible

pre-op assessment (contd.)

Assessment of the airway
General appearance of the neck, maxilla,
mandible
Jaw movement
Head extension and neck movement
The teeth and oropharynx
The soft tissue of the neck
Recent spine and chest X-rays
Previous anaesthetic record

ANATOMICAL PROBLEMS
Short and muscular neck
Protruding and loose teeth
Long, high arched palate
Receding lower jaw
Poor mobility of mandible
Increase anterior depth of mandible
Increase posterior depth of mandible
Decrease atlanto-occipital distance

pre-op assessment (contd.)

Features of clinical examination relevant to the

anaesthetist
General
Nutritional state, fluid balance, anemia,
jaundice, perfusion, temperature

- Cardiovascular

Peripheral pulse (rate,rhythm,pulse)

JVP and pulsation
Arterial pulsation
Heart sounds
Carotid bruits
Dependent oedema

pre-op assessment (contd.)

- Respiratory

Airway

Nervous

Central vs. peripheral cyanosis

Observation of dyspnea
Auscultation of lung fields
Mouth opening
Neck movements
Dentition & thyromental distance
Dysfunction of special nerves, cranial
nerves, peripheral motor and sensory
nerves

pre-op assessment (contd.)

PROBLEMS MECHANISM
Special Investigations
- Full blood count provides information on Hemoglobin
concentration, platelet count, WBC,etc. Hb
important, esp. signs of anemia,
previous bleeding,
etc.
- Urinalysis Reveal UTI, undiag. DM,
- Coagulation
worth considering potential coagulation
disturbances esp. in RA techniques, or possibility of
blood loss during surgery
Check : PT, aPTT, TEG

pre-op assessment (contd.)

PROBLEMS
MECHANISM
- Blood Chemistry ??
-

ECG

Chest X-Ray

PFT

esp. >40-45 y.o, to assess pathological

conditions of the heart as a
preoperative baseline esp. in patients
w/out clinical complaints
esp.in older patients, as a preoperative
baseline of CVS and respiratory
pathological condition
to assess possible risks, predictive
values, and to assess the effects of
postoperative complications