Pre operative Evaluation in anesthesiology

the operative evaluation.. barash

1. Pre operative Evaluation

2. Goals of preanesthetic evaluation To reduced Patient's Risk and Morbidity Associated with Surgery To Formulate Patient -Tailored Anesthetic plan. (According to the requirements and comorbidity.)

3. General Examination and Systemic evaluation Routine General examination and system-wise screen in pre-anesthetic evaluation to reveal any undiagnosed or any overlooked disease or condition. CVS: Undiagnosed or Uncontrolled HTN, Angina, Any Features of CHF, ongoing ischemia.ETC. Respiratory System: History of exercise tolerance as surgery and anesthesia requires more than normal cardiac output (one of the best measure of cardiovascular and respiratory status of the patient).

4. Take a Focused History-apart from regular history, we must include any previous exposure from anesthesia and any untoward effects. Previous medications and history of allergies History of surgical condition for which he/she is being operated. How do we do preanesthetic Evaluation?

5. Response to Previous Anesthetics. The ability to review previous anesthetic records is particularly helpful for detecting the presence of a difficult airway, a history of malignant hyperthermia (MH), and the individual’s response to surgical stress and specific anesthetics. The patient should be questioned regarding any previous personal or familial difficulties with anesthesia. A patient’s report of an “allergy” to anesthesia should raise suspicion for MH. A diagnosis of MH susceptibility will affect the anesthetic regimen and bring into question the appropriateness of outpatient surgery.

6. Although not life-threatening, persistent nausea and vomiting after a previous surgery may be the patient’s most negative and lasting memory. . Postoperative nausea and vomiting (PONV)

7. . Postoperative nausea and vomiting (PONV)

8. Screening Patients Using a Systems Approach

9. NPO STATUS

10. History of OSA Orthopnea? Evaluation of the airway involves examination of the oral cavity, including dentition, determination of the thyromental distance, assessment of the size of the patient’s neck and potential tracheal deviation or masses, as well as evaluation of their ability to flex the base of the neck and extend the head. For trauma patients or patients with severe rheumatoid arthritis (RA) or Down syndrome, assessment of the cervical spine is critical. The presence of symptoms or signs of cervical cord compression should be assessed. In some instances, radiographic examination may also be required. Airway Evaluation

11. Airway Evaluation

12. Pulmonary System A screening evaluation should include questions regarding the history of tobacco use, dyspnea, exercise tolerance, cough, wheezing, bronchodilator or steroid use, recent upper respiratory tract infection, stridor, and snoring or sleep apnea. Physical examination should assess respiratory rate, chest excursion, use of accessory muscles, nail color, and the patient’s ability to carry on a conversation or to walk without dyspnea. Auscultation can detect decreased breath sounds, wheezing, stridor, or crackles. Perioperative pulmonary complications include atelectasis, pneumonia, exacerbation of chronic obstructive pulmonary disease, pulmonary edema, and respiratory failure requiring mechanical ventilation. Postoperative respiratory failure is a major cause of morbidity and mortality, contributing to increased length of hospital stay and substantial economic cost. Pulmonary System

13. Cardiovascular System When screening a patient for cardiovascular disease prior to surgery, the anesthesiologist is most interested in recognizing signs and symptoms of uncontrolled hypertension and unstable cardiac disease such as myocardial ischemia, congestive heart failure, valvular heart disease, and significant cardiac dysrhythmias. Symptoms of cardiovascular disease should be carefully sought, particularly the characteristics of dyspnea, chest pain, or syncope, as well as exercise tolerance. Cardiovascular system

14. Neurologic System

15. Neurologic S ystem

16. Endocrine System Each patient should be questioned for a history or symptoms of endocrine diseases that may affect the perioperative course: diabetes mellitus, thyroid disease, parathyroid disease, endocrine-secreting tumors, and adrenal cortical suppression. Endocrine System

17. Social History Smoking History Alcohol Consumption Illicit Drug Use

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