PRE ANESTHETIC ASSESSMENT

Dr. Rachel
PG 1st Year
 INTRODUCTION
 The Anesthesia Pre operative evaluation is the clinical foundation
for guiding perioperative patient management, reduces
perioperative morbidity and enhances patient outcome

 Includes a focused clinical examination, documentation of

comorbid illness, reduce patient’s anxiety through education
( rapport to be established) , assurances that pre existing medical
conditions are optimally managed, selective referrals to specialists,
ordering of preoperative investigations, arrangements for
peri operative care, recommendations to delay or cancel procedure
if deemed appropriate.
 Goals of pre anesthetic evaluation are two fold- i) to ensure
patients can tolerate anesthesia for planned surgical
procedures
ii) to mitigate risks associated with overall
perioperative period.
Components of Medical History
 Indication for surgery and planned procedure
 Current and past medical illness, previous surgical procedures
type of anesthesia given and anesthesia related complications.
 Any medications taken by patient, tobacco, alcohol or illlicit
drugs.
 Personal or family history, sleep apnea
 History of any drug allergies or adverse effects
 Patient’s exercise or work activity can be quantified in metabolic
equivalents of the task (METs), which is a measure of the volume
of oxygen consumed during an activity.
 Poor METs may be the cause or result of cardiopulmonary
disease.
Physical examination:

 Vital signs:
- Arterial blood pressure (BP)
- Heart rate (HR)
- Oxygen saturation
- Respiration rate
- Height / weight/ BMI
- Increased BMI is
Predictive of difficulties
in airway management
AIRWAY ASSESSMENT
 Mouth opening
 Malampati score:

 Status of teeth
 Degree of neck mobility
 Neck circumference( increased size predicts difficulty with
laryngoscope)
 Thyromental distance, Sternomental distance, upper lip bite test,
mandibular protrusion test
 Body habitus, Spine - deformities
Potential difficulty with ventilation by bag and mask:
 Age of 55 years or more
 BMI exceeding 26
 Lack of teeth
 Beard
 History of snoring
Patients with following characteristics may pose a challenge to ventilate by
any mechanism:
 OSA
 Obesity
 Increased neck circumference(> 17inches in men , >16 inches in women)
 Thyromental distance less than 7 cm with head in maximum extension
 Higher Mallampati scores
 Large tongue
 Inability to protrude the mandible or lower teeth in front of the upper
teeth
 Facial and neck deformities from previous surgery
 Head and neck trauma
 Rheumatoid arthritis
 Down syndrome
 Sceloderma
 Cervical spine disease or previous spine surgery
Modified Mallampati Score

 Class I : full view of soft palate, uvula, tonsillar pillars

 Class II: Soft palate and base of uvula
 Class III: Soft palate
 Class IV: Hard Palate only
GENERAL AND SYSTEMIC EXAMINATION:
 Pallor , icterus, cyanosis, clubbing, lymphadenopathy, pedal
edema
 Systemic examination:
CVS: Heart sounds, any murmurs
RS: Breath sounds, crackles, crepitus, wheeze
Abdomen: Organomegaly
CNS: mental status, speech,cranial nerves, gait, motor and sensory
function
Pre operative Risk assessment
PRE OPERATIVE LABORATORY TESTING:
 Blood Count:
-Extremes of age
-Liver or Kidney disease
-Anti Cogulant use
-Bleeding/hematologic disorder
-Malignancy
-Type and invasiveness of procedure

 Coagulation studies:
-Liver or kidney disease
-Bleeding disorder
-anticoagulant use
-Chemotherapy
 Serum Chemistries:
Liver or renal disease, perioperative risk of dysfunction
Diabetes
Diuretic, digoxin, steriod use
Elderly
Malnutition
Type and invasiveness of procedure

 Chest Xray:
Pulmonary disease or clinical manifestation
Unstable cardiovascular disease
Type and Invasiveness of procedure

 ECG:
CVD or clinical risk factors
Pulmonary disease
Type and invasiveness of procedure
Prevention of Perioperative Pulmonary
Aspiration
 ASA fasting guidelines:
Clear fluids stop at least 2hrs prior to surgery
Breast milk -4hrs
Infant formula - 6hrs
Nin human milk – 6hrs
Light meal- 6hrs
Factors predisposing to Apiration
1- Emergency surgery
2- Inadequate Anesthesia
3- Abdominal pathology
4- obesity
5- opioid medication
6- neurologic deficit
7- lithotomy
8- difficult intubation/ airway
9- refux
10- hiatal hernia
 Psychological Preparation
 Pre medications:
Night before procedure:
-proton pump inhibitors/ H2 receptor antagonists- reduce
risk of pulmonary aspiration
- oral benzodiazepine
Day of Procedure:
- benzodiazepine
-opioids
-Anticholinergics

 Antibiotic Prophylaxsis
THANK YOU