PAC

Outline
• PAC-Introduction
• ASA Grading
• METS
• BMI
• NPO Guidelines
• Airway Assessment
 Introduction: Preoperative assessment

• All patients planned for surgery must undergo

preoperative evaluation
• The principle aims of PAC are to:
1. Assess perioperative risk,
2. Optimise the primary and co-morbid condition
3. Minimize that risk further by producing a tailored and
individualized anesthesia plan,
4. Educate the patient about the process, choices and
expectations
5. Informed consent.
ASSESSMENT OF PREOPERATIVE
RISK
 History
• Planned procedure,
• Presenting illness,
• Comorbid conditions (pre-existing diseases and new Ds),
• Detailed review of organ systems,
• Past anesthetic history with review of complications,
• Assessment of allergies and medications,
• Documentation of substance use or abuse, and
• The last oral intake(NPO).
• If any abnormlity/disease is found:
– Severity of disease,
– efficacy of treatment, and
– impact on daily function
• Always check all previous medical and Anesthesia records
 Examination
• General physical examination, including
– Weight, Height and BMI
• Examination of organ systems, esp. which
were found abnormal in History.
• Airway Examination: In ALL Patients
• Spine/Back especially if spinal/epidural
anaesthesia is planned
– Site of injection in cases of regional anesthesia
 Investigations
• Standard Guidelines state that:
Investigations are indicated for evaluating existing
medical conditions or for disease diagnosis only when
an abnormal result will have an impact on
management of the patient or direct further testing
• Routine investigations are not indicated
• Our institute recommends only following
routine investigations for all patients:
– Hemogram
– Viral markers for HIV, Hepatitis B &C