PAC - Pre Anaesthetic Checkup

Fast Overview on Pre Anesthetic Check up

1. Pre Anaesthetic
Patient Assessment
Mr Harshad Khade
M.Sc. Medical Technology
Symbiosis International University, Pune

2. Pre Anaesthetic
Check-up
Fast Overview on Pre Anestheticcheck-up.

3. Pre Anaesthetic Check-up
•Process of clinical assessment that precedes the delivery of anesthesia
care for surgery and non surgical procedures.
•Patients medical records, interview, physical examination &
investigations.
•First introduction of anesthesia to the patient.
•Reduce patient anxiety before surgery and may even decrease post
operative pain and length of hospital stay.

4. Goals of
PAC
•Evaluation of
patients general
health
•Anticipation of
possible
complications
Objective of
PAC
•Doctors patient
relationship
•Patient data
•Anesthesia plan
•Patient consent
Steps of
preoperative visit
•Problem Identification
•Risk Assessment
•Preoperative
Preparation
•Plan of anesthetic
technique

5. HISTORY
1. Identification of the patient
Name: Age: Sex:
Review file
1.Preoperative Diagnosis:
2.Plan of Operation:
3.Mode of Anesthesia: RA/LA/GA
2.History of previous anesthesia
1.Allergy from drugs
2.Post operative Nausea & Vomiting
3.Anesthesia awareness
4.Difficult intubation
5.Delayed Emergency
3. Past Medical history
1.DM, HTN, COPD, CAD
2.Regular medications
3.Previous surgery:-
Date: Type of Anesthesia:
4. Personal history
Smoking, Alcohol, Drug abuse.
5. Family history
Problems with Anesthesia in family
6. Menstrual history
1.Pregnancy
2.LMP

6. Examination
1. General examination
•Weight, BMI,
•Pallor, Cyanosis,
•Clubbing, Edema,
•Dehydration.
Vital signs :-
•SPO2, Pulse,
•Blood Pressure,
•Temperature,
•Respiratory rate.
2.Systemic examination
•Chest
•CVS
•CNS
3. Local examination
•Spine:-deformity
•Nasal cavity:-obstruction
•Oral cavity :-
teeth, dentures, tongue
•Peripheral venous access

7. Airway Assessment
MallampatiClassification
Grade 1Glottis Fully Visible.
Grade 2Only Posterior Glottis Visible.
Grade 3Only Epiglottis Visible
Grade 4No Recognizable Structures.

8. Investigations
Basic investigations
•CBC :-Hb, TC / DC
•ABO Rh typing
•RBS
•Urea, Creatinine, Na+, K+, Cl+.
•PT / INR
•ECG
•Chest X-Ray
Other investigations ( if needed )
Echocardiography
TFT
HbA1c
HBsAg, HCV, HIV.
BT / CT
LFT
PFT

9. Risk Assessment
ASA PS
Classification
Definition
ASA 1 A normal healthy patient.
ASA 2 A patient with mild systemic disease.
ASA 3 A patient with sever systemic disease.
ASA 4 A patient with sever systemic disease,
that is a constant threat to life.
ASA 5 A moribund patient who is not expected to survive
without the operation.
ASA 6 A declared braindead patient,
whose organs are being remove for donor purposes.
E Denotes Emergency surgery.

10. ASA Fasting Guidelines
ASA Fasting Guidelines
Clear fluid 2 Hours Water,
Fruit Juicewithout pulp,
Carbonated beverages,
Black Tea, Black Coffee.
Milk Adult :-4 Hours
Infant :-6 Hours
LightFood 6 Hours Fruits,
Fruits Juice with pulp,
Vegetables.
HeavyFood 8 Hours Fatty meals,
Meats.

11. Medication Management
Medications Day before Surgery Atthe surgery Day
Levothyroxine Continue Continue
CCB Continue Continue
Beta Blockers Continue Continue
ACEi/ ARB Continue Hold
Diuretics Continue Hold
Metformin Hold Hold
OHA Continue Hold
Inhaled bronchodilators Continue Continue

12. Thank You