Evaluation before Anesthesia

Dr. Weiwei Liu

2021.09
Department of Anesthesiology
The First People's Hospital of Jingzhou
The First Affiliated Hospital of Yangtze University
What should we do ?

What is the purpose?

 Teaching aims
History
The physical examination
Laboratory studies
Anesthesiologist-patient relationship
Premedication
Delaying surgical procedures
 Objectives

Establish a doctor-patient relationship

Become familiar with the surgical illness and
coexisting medical conditions
Develop a management strategy for preioperative
anesthetic care
Obtain informed consent for the anesthetic plan
 Objectives

reduce perioperative morbidity and mortality

allay patient anxiety
 History
The doctor knew
everything about
me ,and I felt
reassured that he must
be a good doctor

medical record Patient interview

 History

General condition
Anesthetic history
Family history
Social history and habits
Review of systems
 History
General condition

Present surgical illness

Diagnostic studies performed
Presummptive diagnosis
Initial treatment and responses
 History
General condition
Coexisting illnesses
Drugs
Allergies and drug reactions
True allergic reactions
Adverse reactions and side effects
Certain rare but important drug interactions
 History
Coexisting illness

These should be evaluated in a systematic approach with

an emphasis on recent changes in symptoms,signs,and
treatment .

Unusual laboratory tests

Unfamiliar drug therapies
Changes in the patient’s baseline status
 History
Drugs
i.e
antihypertensive ,antianginal,
antiarrhythmic,anticoagulant,
anticonvulsant,and specific
endocrine medication.

Their dosages ,and schedules

must be ascertained .

Most medication can be continued up to the time of surgery

 History
Allergies and drug reactions

True allergic :
skin manifestation,facial or oral swelling,shortness of
breath,choking,wheezing,or vascular collapse.
• Antibiotics
• Soybean oil and egg yolk
• Local anesthetics
• Shellfish or seafood
Adverse reactions and side effects
Certain rare but important drug interactions
 History
What is serotonin syndrome (SS)?

serotonin syndrome, SS
 History
Anesthetic history
Family history
Social history and habits
Smoking:hyperresponsiveness and postoperative
pulmonary complications.
Drugs and alcohol
 History
Drugs and alcohol:
Stimulant abuse :palpitations,angina,weight loss,and lowered
thresholds for serious arrhythmias and seizures.
Acute alcohol intoxication :decrease the anesthetic
requirements ,hypothermia,and hypoglycemia
Opioids and benzodiazepines : increase the doses needed to
induce and maintain anesthesia or to provide adequate
postoperative analgesia.
 History
Review of systems
A recent history of an upper respiratory infection,
especially in children
Asthma
Preexisting coronary artery disease (CAD)
Diabetes
Untreated hypertension
Likelihood of pregnancy
 The physical examination
Vital signs
Head and neck
Lungs
Abdomen
Extremities
Neurologic examination
 The physical examination
Vital signs
Height and weight
Blood pressure
Resting pulse
Respirations
 The physical examination
Head and neck
Lungs
Abdomen
Extremities
Neurologic examination
 Laboratory studies

Hematological studies
Serum chemistry studies
ECG
Chest radiography
Pulmonary function tests
 Laboratory studies

Hematological studies

Serum chemistry
studies
 Laboratory studies
ECG
Men >45y
Women>55y
 Laboratory studies

Chest radiography
heavy smokers
 the elderly
 pulmonary symptoms or
symptomatic heart disease

Pulmonary function
tests
 Anesthesiologist-patient relationship
Conducting an unhurried organized
interview
ASA guidelines for nil per os (NPO) status preoperatively
Nonhuman Fried fatty
Clear liquids Breast milk
Age milk/light foods/meat
(hours) (hours)
snack(hours) (hours)
infant
2 4 6 8

child
2 4 6 8

adult
2 N/A 6 8
 Anesthesiologist-patient relationship
Conducting an unhurried organized interview
The estimated time of surgery
Medications to be continued
Premedications
Management of aspirin and nonsteroidal
antinflammatory drugs (NSAID) therapy
Procedures that will occur on the day of surgery
Plans for postoperative recovery in the PACU or ICU
Plans for postoperative pain control
Anesthesiologist-patient relationship
Informed consent
Certain aspects of
anesthetic management
Alternatives to the
suggested management
plan
Risks associated with
anesthesia-related
procedures
 Anesthesiologist-patient relationship
ASA Physical Status classification Example

Ⅰ No organic/physiologic/psychiatric problem Healthy patient

Ⅱ A patient with mild systemic disease Controlled HTN/

and no functional limitations smoker/obesity
Ⅲ A patient with moderate to severe systemic Controlled
disease that results in some function limitation CHF/stable
angina/COPD
Ⅳ A patient with severe systemic disease that is a Unstable angina/
constant threat to life and functionally Symptomatic COPD
incapacitating Or CHF
Ⅴ A moribund patient who is not expected
to survive 24 hrs with or without surgery
Ⅵ Brain dead, undergoing organ donation

E Emergency, trauma Gunshot wound

 Premedication
Untreated hypertension (HTN)
Coronary artery disease CAD
Asthma
hyperglycemie or lypoglycemic
pulmonary aspiration
sedatives and analgesics
Anticholinergics
Antiemetic agents
 Delaying surgical procedures
Myocardial infarction within 6 months
New-onset atrial fibrillation, atrial flutter
Coagulopathy
Hypoxia of unclear etiology
Administrative uncertainties
 Brief Summary
History
The physical examination
Laboratory studies
Anesthesiologist-patient relationship
Premedication
Delaying surgical procedures
 Question after Class

What are the specific objectives of pre-anesthetic

evaluation？

What is the patient’s ASA scale ？

What are the Guidelines for NPO Status？
Suggested Reading

Miller’s Anesthesia[M].8th ed.

Miller’s Anesthesia[M].8th ed.
THANK YOU