Preoperative Evaluation and choice of Anesthetic Technique

Preoperative evaluation and preparation for anesthesia begins when the anesthesiologist reviews the patient’s medical record and visits the patient the day before elective surgery

Important aspects of the preoperative evaluation include:
• • • • • • • • • • History Review of current drug therapy Physical examination Interpretation of laboratory data Consent Planned management of anesthesia Methods available for relief of post operative pain Fasting Assignment the physical status classification Premedication

History
• 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Previous adverse responses related to anesthesia Allergic reactions Prolonged skeletal muscle paralysis Delayed awakening Nausea and vomiting Hoarseness Myalgia Hemorrhage Jaundice Post spinal headache Adverse responses in relatives

• 2. 3. • 6. 7. 8. 9. 10. 11. 12.

Central nervous system Cerebrovascular insufficiency Seizures Cardiovascular system Exercise tolerance Angina pectoris Prior myocardial infarction Hypertension Rheumatic fever Claudication dysrhythmias

• 2. 3. 4. 5. 6. 7. 8.

Lungs Exercise tolerance Dyspnea and orthopnea Cough and sputum production Bronchial asthma Cigarette consumption Pneumonia Recent upper respiratory tract infection

• 2. 3. • 6. 7. •

Liver Ethanol consumption Hepatitis Kidneys Nocturia Pyuria

Skeletal and muscular systems 10. Arthritis 11. Osteoporosis 12. Weakness

• 2. 3. 4.

Endocrine system Diabetes mellitus Thyroid gland dysfunction Adrenal gland dysfunction

• Coagulation 8. Bleeding tendency 9. Easy bruising 10. Hereditary coagulopathies

Reproductive system 2. Menstrual history 3. Sexually transmitted diseases

• Dentition 7. Dentures 8. Caps

Drug usage and potential interactions with drugs administered in the Perioperative period
Alcohol abuse • tolerance to anesthetic drugs • Prolongation of muscle relaxants • Impaired sympathetic nervous system responses

Antibiotics

Antihypertensive

Aspirin Benzodiazepines

• Bleeding tendency • Tolerance to anesthetic drugs • Bradycardia • Bronchospasm • Impaired sympathetic nervous system responses • Myocardial depression

Beta antagonists

Calcium channel blockers Digitalis

• Hypotension • Cardiac dysrhythmias or conduction disturbances • Hypokalemia, Hypovolemia • Exaggerated response to sympathomimetic drugs with acute treatment • Exaggerated response to sympathomimetic drugs with acute treatment

Diuretics Monoamine oxidase inhibitors

Tricyclic antidepressants

Physical examination
• Central nervous system
1. Level of consciousness 2. Evidence of peripheral sensory or skeletal muscle dysfunction

Cardiovascular system

3. Auscultation of the heart (heart rate, rhythm, murmur) 4. Blood pressure (supine and standing ) 5. Peripheral pulses (arterial cannulation site) 6. Veins (access site) 7. Peripheral edema

Lungs

2. Auscultation of the lungs (rales, wheezes) 3. Pattern of breathing 4. Anatomy of thorax (emphysema)


2. 3. 4. 5. 6. 7.

Upper airway
Cervical spine mobility Temporomandibular mobility Prominent central incisors Diseased or artificial teeth Ability to visualize uvula Thyromental distance

Coagulation
Bruising Petechiae

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