Pre_Anesthetic_Evaluation_OMFS_Detailed.pptx

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1. Pre-Anesthetic Evaluation in Oral & Maxillofacial Surgery Pre-Anesthetic Evaluation — Oral & Maxillofacial Surgery Detailed overview with practical guidance

2. Learning Objectives Understand components of pre-anesthetic assessment Recognize airway assessment tools and red flags Identify common system-specific perioperative concerns Formulate a basic perioperative plan and documentation

3. Why Pre-Anesthetic Evaluation Matters Reduces perioperative morbidity and mortality Identifies modifiable risks preoperatively Guides anesthetic technique and monitoring Improves informed consent and patient counseling

4. Pre-Operative Checklist (Overview) Medical & surgical history review Focused physical examination including airway Relevant investigations & optimization Consent, fasting status, medication plan

5. History — General Medical History Chronic illnesses: HTN, DM, CAD, COPD Recent infections, fever, or hospitalizations Prior anesthetic complications or family history of malignant hyperthermia Functional status and exercise tolerance

6. Medications, Allergies & Social History Current medications (anticoagulants, insulin, steroids) Allergies—drug, food, latex (nature of reaction) Smoking, alcohol, recreational drugs Home oxygen or CPAP use

7. Physical Examination — Vitals & General Blood pressure, heart rate, respiratory rate, SpO2, temperature Weight & BMI (dosing & airway implications) General appearance: frailty, cachexia, cyanosis

8. Airway Evaluation — Components Mallampati score Mouth opening (interincisor distance) Thyromental distance & neck mobility Dentition and presence of loose teeth or prostheses

9. Mallampati Classification (I–IV) Grade I: Soft palate, fauces, uvula, pillars visible Grade II: Soft palate, fauces, uvula visible Grade III: Only soft palate & base of uvula visible Grade IV: Only hard palate visible

10. Mouth Opening & Thyromental Distance Interincisor distance <3–4 cm suggests limited opening Thyromental distance <6 cm increases difficulty risk Assess temporomandibular joint mobility and trismus

11. Neck Mobility & Dentition Cervical spine extension and flexion Previous neck surgery or radiation limits mobility Document loose teeth, carious roots, prostheses Plan for dental protection during intubation

12. Cardiovascular Assessment History of ischemic heart disease, heart failure, arrhythmias Current symptoms: chest pain, syncope, exertional dyspnea ECG and cardiology referral if indicated

13. Respiratory Assessment Assess baseline breathlessness, cough, sputum, sleep-disordered breathing Active lower respiratory infection—consider postponement Pulmonary function testing for severe disease

14. Laboratory & Investigations — Routine CBC (anemia, infection), RFT (renal function), LFT Coagulation profile if bleeding risk or liver disease Blood glucose, electrolytes as indicated

15. ECG & Chest X‑Ray — Indications ECG for patients >50 or with cardiac disease/symptoms Chest X-ray for respiratory disease, recent chest infection, or complex surgery Tailor imaging to clinical suspicion, not routinely for all

16. ASA Physical Status Classification ASA I — Healthy patient ASA II — Mild systemic disease ASA III — Severe systemic disease ASA IV — Severe disease, constant threat to life ASA V — Moribund, not expected to survive without operation

17. Fasting Guidelines & Preoperative Preparation Clear fluids until 2 hours before elective anesthesia Breast milk 4 hours; solids 6–8 hours depending on meal Adjust diabetic medications and insulin per protocol Continue essential cardiac meds (consult guidelines)

18. Anticoagulants & Antiplatelet Management Assess bleeding risk vs thrombotic risk Warfarin: INR target & periop holding/bridging plan DOACs: timing of interruption based on renal function and bleeding risk Aspirin/Clopidogrel — consult cardiology for high-risk stents

19. Diabetes — Perioperative Glycemic Control Target perioperative glucose commonly 140–180 mg/dL Short-acting insulin adjustments and sliding scales Avoid prolonged fasting—adjust oral hypoglycemics Monitor glucose intra‑/post‑operatively

20. Hypertension & Cardiac Risk Optimization Record baseline BP; address hypertensive urgency/emergency Continue most antihypertensives perioperatively (e.g., beta‑blockers) Delay elective surgery for uncontrolled severe HTN

21. Obstructive Sleep Apnea (OSA) in OMFS OSA increases perioperative airway and respiratory risks Use STOP‑BANG screening; consider high-risk status Continue CPAP postoperatively when possible; plan monitoring

22. Anticipated Difficult Airway — Planning Create an airway plan with alternatives (Plan A–D) Ensure availability of adjuncts: video laryngoscope, bougie, fiberoptic scope, supraglottic devices Communicate with surgical team about emergency surgical airway readiness

23. Informed Consent & Documentation Explain anesthesia risks specific to OMFS (airway compromise, dental injury) Document fasting, meds held, investigations reviewed, and optimization steps Record the agreed anesthetic plan and contingency measures

24. Age-Specific Considerations: Pediatric & Geriatric Pediatrics: pre-op fasting, inhalation vs IV induction, parental presence, dosing Geriatrics: frailty, polypharmacy, altered pharmacokinetics, cognitive risk Both groups need tailored assessment and monitoring

25. Postoperative Monitoring & Discharge Criteria Monitoring for airway obstruction, bleeding, respiratory compromise Pain control plan and opioid-sparing strategies Criteria: stable vitals, controlled pain/nausea, safe airway, responsible escort

26. Key Points Checklist for OMFS Pre-Anesthetic Evaluation Systematic airway assessment and plan Identify and optimize comorbid conditions Appropriate investigations guided by risk Clear documentation & team communication

27. References & Suggested Reading Textbooks: Miller's Anesthesia, Stoelting & Dierdorf Guidelines: ASA fasting & perioperative practice statements; local hospital protocols Journals: British Journal of Oral & Maxillofacial Surgery; Anesthesiology; Clinical Anesthesia