Understanding Anesthesiology - The Global Regional Anesthesia ...

SECTION 1
Pre-operative Evaluation
In This Section
1. Pre-operative Visit
2. NPO Status
3. Premedication
Pre-operative Visit
The purpose of the pre-operative assessment is
three-fold:
• To review the medical and psychological status of
the patient.
• To identify factors which may impact on the perioperative
course, to take measures to optimize those
factors where possible, and to delay surgery if necessary.
If the patient’s medical condition cannot
be altered, then one can take other measures to
attempt to reduce risk: substitute a lower-risk
surgical procedure, modify the anesthetic technique,
intensify the peri-operative monitoring
or cancel the surgery altogether.
• To inform patient, alleviate anxiety and establish
rapport.
This evaluation takes the form of a directed history,
physical examination and laboratory exam.
On history, the anesthesiologist attempts to elicit
symptoms of cardiac or respiratory disease as
well as a history of any other major medical illnesses,
past or present. Hepatic or renal disease
may impact on metabolism and excretion of anesthetic
agents, fluid balance and coagulation
status. The patient’s medications are reviewed
including any history of adverse drug reactions.
The patient’s and their relative’s previous anesthetic
experience is reviewed.
The physical examination focuses on the cardiac
and respiratory (including airway) systems. Recording
baseline vital signs is important, as is detecting
any unstable, potentially reversible conditions
such as congestive heart failure or bronchospasm.
The airway is assessed for ease of intubation.
Routine pre-op laboratory investigations have
not been shown to improve patient outcome.
Therefore, laboratory studies are ordered only as
indicated, according to the medical status of the
patient and the nature of the planned surgery.
Studies are rarely ordered to establish a “baseline”
but rather to detect abnormalities that require
correction prior to surgery. The traditional
“CBC and urinalysis” is no longer required in
healthy patients having minor surgery. An electrocardiogram
(ECG) is ordered on patients who
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