Overall aims of Pre-Op Assessment :

Realistic benefits >< risks of surgeryAnticipate potential problemsEnsure the patient is prepared Information and consent to patientPremedication and/or prophylactic

PREOPERATIVE ASSESSMENTPROBLEMS MECHANISMASA INormally healthy individualsAnamnesis - Current conditionSystemic effect, potential effects on perioperative management e.g CVS disturbance, severe anemia, nutritional status- Anaesthetic/Surgery Historyto anticipate & encounter problems e.g problems in intubation, side effects of drugs, .?

pre-op assesment (Contd.)PROBLEMSMECHANISMDrug historyDrug interaction during anaesthesia, dose adjusment e.g antidepressant agents, antidiabetics, diuretics, MAOI, antihypertensive agentsMedical historyto anticipate problems, esp. CVS and respiratory problems and previous illness duringanaesthesia e.g Asthma, bronchitis, TB, angina/MI episodes, CHF history, Diabetes MellitusAllergic Historyto anticipate and distinguish true allergy and adverse reaction e.g anaesthetic drugs, hyperactivity of vasoactive drugs in atopic individuals

pre-op assessment (contd.)PROBLEMSMECHANISMSmoking 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.)PROBLEMSMECHANISM

AlcoholFrequency, amount and type of liquor organ damage hepatotoxic, cardiomyopathy, gastritis, pancreatitis adverse reaction on drugs, increase risk, dose tolerance esp. on barbiturates

Family historyhemoglobinopathies, blood dyscracia, hemostatic problems

PROBLEMSMECHANISM

Physical diagnosticGeneral 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 riskCVS signsCough, thick sputum, dyspneu causing the risk of respiratory problem during surgery

pre-op assessment (contd.)

PROBLEMMECHANISM

Airway manag.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 visiblepre-op assessment (contd.)

Assessment of the airwayGeneral appearance of the neck, maxilla, mandibleJaw movementHead extension and neck movementThe teeth and oropharynxThe soft tissue of the neckRecent spine and chest X-raysPrevious anaesthetic record

pre-op assessment (contd.)

ANATOMICAL PROBLEMSShort and muscular neckProtruding and loose teethLong, high arched palateReceding lower jawPoor mobility of mandibleIncrease anterior depth of mandibleIncrease posterior depth of mandibleDecrease atlanto-occipital distance

Features of clinical examination relevant to the anaesthetistGeneral Nutritional state, fluid balance, anemia, jaundice, perfusion, temperature

- CardiovascularPeripheral pulse (rate,rhythm,pulse)JVP and pulsationArterial pulsationHeart soundsCarotid bruitsDependent oedemapre-op assessment (contd.)

- RespiratoryCentral vs. peripheral cyanosisObservation of dyspneaAuscultation of lung fieldsAirwayMouth openingNeck movementsDentition & thyromental distanceNervousDysfunction of special nerves, cranial nerves, peripheral motor and sensory nervespre-op assessment (contd.)

PROBLEMSMECHANISMSpecial InvestigationsFull blood countprovides information on Hemoglobinconcentration, platelet count, WBC,etc. Hb important, esp. signs of anemia, previous bleeding, etc.UrinalysisReveal UTI, undiag. DM, Coagulation worth considering potential coagulation disturbances esp. in RA techniques, or possibility of blood loss during surgeryCheck : PT, aPTT, TEG

pre-op assessment (contd.)

PROBLEMSMECHANISMBlood Chemistry??

ECGesp. >40-45 y.o, to assess pathological conditions of the heart as a preoperative baseline esp. in patients w/out clinical complaintsChest X-Rayesp.in older patients, as a preoperative baseline of CVS and respiratory pathological conditionPFTto assess possible risks, predictive values, and to assess the effects of postoperative complications

pre-op assessment (contd.)