DEPARTMENT OF ANESTHESIOLOGY
Clinical Clerkship infant, >3 months history of MI, CVA,
San Beda College of Medicine
TOPIC: PREOPERATIVE EVALUATION
WHAT IS PREOPERATIVE EVALUATION?
An interview with the patient and/or
guardian to establish a detailed medical history and
perform complete physical examination prior to
surgery.
It consists of:
1. Present medical illness (reason for surgery)
2. Past medical illness (comorbidities/ past
surgeries/prior anesthesia experience)
3. Family medical history (hereditary disease)
4. Thorough physical examination
a. Head to foot
b. Mallampati score (evaluation of
airway)
5. Appropriate diagnostic testing/ review of the
diagnostic data
6. Assignment of ASA physical score
7. A formulation and discussion of appropriate
anesthetic plans
8. Informed consent
ASA Physical Status Classification (by the ASA house
of delegates Oct 2014)
ASA 1: normal healthy patient (healthy, non-smoking,
no/minimal alcohol use)
ASA 2: patient with mild systemic disease ( mild
disease without substantive functional limitations)
- Current smoker, social alcohol drinker,
pregnancy, obesity (BMI> 30 but < 40),
well controlled DM/HPN, mild lung
disease
ASA 3: patient with severe systemic disease
(substantive functional limitations)
- One or more moderate to severe
diseases
- Poorly controlled DM/HPN, COPD,
morbid obesity (BMI>40), active
hepatitis, alcohol dependence or abuse,
implanted pacemaker, moderate
reduction of ejection fraction, ESRD
undergoing regular dialysis, premature
TIA, CAD
ASA 4: patient with severe systemic disease that is a
constant threat to life
- < 3 months history of MI, CVA, TIA, CAD
- Ongoing cardiac ischemia, severe valve
dysfunction, severe reduction in
ejection fraction, sepsis, DIC, ESRD not
undergoing regular dialysis
ASA 5: moribund patient who is not expected to
survive without the operation
- Ruptured abdominal/thoracic
aneurysm, massive trauma, intracranial
bleed
- Multiple organ system dysfunction
ASA 6: a declared brain dead patient whose organs
are being removed for donor purposes.
** The addition of letter “E” denotes EMERGENCY
Mallampati Scoring
Class I: visualize the soft palate, fauces, uvula,
anterior and posterior pillars
Class II: visualize the soft palate, fauces and uvula
Class III: visualize the soft palate and the base of the
uvula
Class IV: soft palate is not visible at all
Measurements (fingerbreadths)
3 fingers mouth opening
3 fingers hypomental distance (between the tip of the
jaw and the beginning of the neck)
2 fingers between the thyroid notch and the floor of
the mandible
Preoperative laboratory testing
1. CBC – anticipated significant blood loss,
suspected hematological disorder
2. Electrolytes – diuretics, renal disorders
3. ECG – age >40 years old, history of cardiac
disease, hypertension, peripheral vascular
disease, DM, renal thyroid or metabolic
disease
4. Chest xray – pulmonary diseases
1
 5. Urinalysis – DM, renal disease, recent
urinary tract infection

Risk Assessment

Components for evaluating perioperative risks

1. Patient’s medical condition
2. Extent of the surgical procedure
3. Risk from the anesthetic

Common preoperative medications

1. Benzodiazepines (midazolam)
2. Opioids (nalbuphine, tramadol,
butorphanol)
3. Anti-histamines (diphenhydramine,
promethazine)
4. Proton pump inhibitor (omeprazole)
5. H2 blocker (ranitidine)

Fasting recommendations

Clear liquids – 2 hours

Breast milk – 4 hours
Infant formula/non human milk – 6 hours
Light meal – 6 hours
Heavy meal – 8 hours