PreOperative Evaluation and Care

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Pre-Operative Evaluation and Care
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Purpose of Pre-Operative Evaluation

• Establishment of rapport with patient
• Evaluation of laboratory investigations already
  done and to advise for further investigation, if
  required
• Evaluation of co-existing diseases (if any)
• Assessment of risk-benefit ratio about anesthesia
  and surgery and postponement of surgery if needed
• To advise pre-operative instructions
• Planning for anesthesia

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Purpose of Pre-Operative Evaluation

• Pre-operative evaluation includes
• History A full medical history
• Physical examination
• Investigations
• Correct preparation for the operation
• Ensuring adequate facilities and trained staff
  for operation

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Pre-Operative History Taking

• Current medical history
• Anesthetic history
• Family history
• Drug history
• Allergies
• Smoking and alcohol habits
• History of HIV or hepatitis
• History of co-existing disease

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Pre-Operative Physical Examination

• Examination of airway, oral cavity, denture,
  neck, etc.
• Examination of area over vertebral column
• Examination of skin of area where spinal
  anesthesia is to be performed
• Auscultation of heart and lungs
• Measurement of pulse rate and blood pressure
• Measurement of body weight and height

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Pre-Operative Investigations

• Hemoglobin estimation
• Routine urine examination
• Random blood sugar/post-prandial blood sugar, if
  diabetic
• Electrocardiogram and chest x-ray, if patient
  hypertensive or history of ischemic heart disease
  or chronic obstructive pulmonary disease
• Other investigations as required

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ASA Grading

• Grade I Normal healthy patient
• Grade II Patient with mild systemic disease
• Grade III Patient with moderate systemic
  disease not incapacitating life
• Grade IV Patient with severe systemic disease
  that is incapacitating life
• Grade V Moribund patient who is not expecting
  to survive 24 hours with or without operation
• Suffix E Suffix E to any grade indicates
  emergency operation

American Society of Anesthesiologists
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Pre-Operative Preparation

• Fasting for 4 to 6 hours to prevent vomiting and
  dangers of aspiration of gastric content
• Premedication for sedation and to lessen anxiety
• Correction of fluid and electrolyte balance
• Continuation or discontinuation of maintenance
  drugs, if necessary
• Mental preparation for the operation
• Informed consent

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Pre-Operative Evaluation

• Planning for anesthesia
• Choosing type of anesthesia
• Choosing anesthetic drugs