The preoperative assessment plays a crucial role in reducing surgical morbidity by uncovering previously undiagnosed or unstable medical conditions that elevate risk, as well as identifying patients who might improve with preoperative intervention. During the POE, the evaluation of patients set for surgery helps pinpoint those who may require a delay in their surgical procedure or might be unsuitable for surgery altogether. Moreover, for patients proceeding with surgery, the POE aids in coordinating perioperative care resources, devising strategies to manage intraoperative risks, planning for postoperative recovery, and addressing perioperative pain management.
Elements of the Preoperative Assessment
- Evaluation of pertinent medical records
- Findings from preoperative medical tests and evaluations
- Physical examination in advance of the day of the procedure
- neuro/mental, assess competence
- cardiovascular
- respiratory/pulmonary
- renal exam
- vital signs
- full airway exam: Mallampati score, thyromental distance, Sternomental distance, mandibulo-hyoid distance, neck mobility, jaw thrust (prognathism)
- Weight, height, BMI
- Patient Interview - Risk factors for cardiac and pulmonary disease
- A description of current diagnoses and their current status, treatments received, and any medications and alternative therapies used
- Discuss the condition(s) for why surgery is being done
- Past Medical History
- Difficult Airway
- Hypertension
- Previous myocardial infarction (MI)
- Atrial fibrillation or other dysrhythmias
- Pulmonary disease
- Diabetes
- Reaction to any previous anesthetic
- Family member who reported a severe fever or perioperative death after receiving anesthesia
- Family history of pseudocholinesterase deficiency
- Current or past chemotherapy and/or radiation treatment
- Bleeding
- Recent chest pain
- Postoperative nausea and vomiting
- Obstructive sleep apnea; use of CPAP
- Current or past use of tobacco, illicit drugs, and alcohol
- Major trauma
- Blood transfusion
- Allergies to medications (true allergy vs. side effects), type of reaction
- Extremes of age with associated risks
- Exercise tolerance, functional capacity (MET score)
- Current anemia or history of anemia. Anemia has been associated with increased morbidity and mortality though a rather weak independent predictor.
- Current pregnancy
- Routine pregnancy testing is not required for all premenopausal women, BUT careful history regarding possible pregnancy is required and a pregnancy test performed if indicated by history
- Past surgical history
- CABG
- Stents
- Pacemaker or ICD
- Peripheral vascular
- Address anticoagulation issues
- Order consults when appropriate
- Ask “Do you have any other health conditions or issues we have not discussed?”
- Develop perioperative care plan
- Obtain informed consent
- Document anesthetic plan, airway assessment, and discussion of possible dental injury
