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 1. Allergic reactions 2. Prolonged skeletal muscle paralysis3. Delayed awakening4. Nausea and vomiting5. Hoarseness6. Myalgia7. Hemorrhage8. Jaundice9. Post spinal headache10. Adverse responses in relatives

• Central nervous system1. Cerebrovascular insufficiency2. Seizures

• Cardiovascular system1. Exercise tolerance2. Angina pectoris3. Prior myocardial infarction4. Hypertension5. Rheumatic fever6. Claudication7. dysrhythmias

• Lungs1. Exercise tolerance2. Dyspnea and orthopnea3. Cough and sputum production4. Bronchial asthma5. Cigarette consumption6. Pneumonia7. Recent upper respiratory tract infection

• Liver

1. Ethanol consumption

2. Hepatitis

• Kidneys

1. Nocturia

2. Pyuria

• Skeletal and muscular systems

1. Arthritis

2. Osteoporosis

3. Weakness

• Endocrine system1. Diabetes mellitus2. Thyroid gland dysfunction 3. Adrenal gland dysfunction

• Coagulation1. Bleeding tendency2. Easy bruising 3. Hereditary coagulopathies

• Reproductive system

1. Menstrual history

2. Sexually transmitted diseases

• Dentition

1. Dentures

2. Caps

Drug usage and potential interactions with

drugs administered in the Perioperative period

Alcohol abuse

Antibiotics

Antihypertensive

• tolerance to anesthetic drugs

• Prolongation of muscle relaxants

• Impaired sympathetic nervous system responses

Aspirin

Benzodiazepines

Beta antagonists

• Bleeding tendency

• Tolerance to anesthetic drugs

• Bradycardia• Bronchospasm• Impaired sympathetic

nervous system responses

• Myocardial depression

Calcium channel blockers

Digitalis

Diuretics

Monoamine oxidase inhibitors

Tricyclic antidepressants

• Hypotension

• Cardiac dysrhythmias or conduction disturbances

• Hypokalemia, Hypovolemia

• Exaggerated response to sympathomimetic drugs with acute treatment

• Exaggerated response to sympathomimetic drugs with acute treatment

Physical examination

• Central nervous system1. Level of consciousness

2. Evidence of peripheral sensory or skeletal muscle dysfunction

• Cardiovascular system

1. Auscultation of the heart (heart rate, rhythm, murmur)

2. Blood pressure (supine and standing )

3. Peripheral pulses (arterial cannulation site)

4. Veins (access site)

5. Peripheral edema

• Lungs1. Auscultation of the lungs (rales, wheezes)

2. Pattern of breathing

3. Anatomy of thorax (emphysema)

• Upper airway1. Cervical spine mobility

2. Temporomandibular mobility

3. Prominent central incisors

4. Diseased or artificial teeth

5. Ability to visualize uvula

6. Thyromental distance

• CoagulationBruising

Petechiae

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