Specialization : Anesthesia

Academic Level : Level one

Search : BIASI
Preparing students /
Kholood AL- Naqeeb
Sadiq Saadan
Ashjan Khaled
Omar Alsamei The supervision /
Aisha Mohammed Hussein AL - Hakimi
Tamim Fadl
Wasim
 BASSIC
PATIENT ASSESSMENT

INTRODUCTION :
The per operative assessment
should establish the state of health
of patient Per operative evaluation
of that include the requirement
that anesthesiologist shall be
responsible for:
Follow The Introduction :

 Determining the medical status of the

patient.

 Reviewing with the patient or a

responsible adult the proposed care plan.

 An important aspect of the preoperative

visit is to inform the patient and other
interested adults about events to expect
on the day of surgery and discuses the
risks associated with anesthesia .
SYMPTOMS OF THE DISEASE Goal of the per operative assessments :

Informed the patient : Educate the patient : The obtaining information:

Informed the patient of risk Educate the patient regarding the The obtaining complete
so that an informed consent anesthesia and event to take place in information about the patient’s
can be made. the peril operative period. medical history and surgical
diagnosis :
 this will a uncover important medical conditions like

81 Hypertension
% Ischemic
54 Heart Disease
%
42 Asthma
%
23 Gastric Reflux
%

06
Allergies Which Have Special Relevance To Anesthesia.
12
%
peril operative
morbidity
Goal of the per operative assessments :

 Establishment of good rapport with the patient

and his attendant this is more important ( and
often better ) then pharmacology
premedication – the patient gets an idea of the
surgical and anesthetic plan and options
available … He can clarify any doubts or
anxieties … He may have about the procedure
pain relief risk … etc.
 Carrying out a complete physical examination
with special emphasis on airway , dentition
cardio respiratory system .. ease of vascular
access and landmarked for regional
anesthesia.
 Decision of operability whether the patient
can tolerate the surgical Proceed.
Goal of the per operative assessments :
• Obtaining informed consent from the patient
after explaining the risks and benefits of the
procedure.
• Planning appropriate anesthetic technique and
nature of surgery positioning the patients .
• Ordering pharmacologic premedication wherever
necessary and appropriate .
• Planning appropriate postoperative care including
analgesia and ventilator support.
• Answer question and reassure the patient and
family .
Goal of the per operative assessments
• Notify the patient about the prohibition of ingesting food.
• Instruct the patient about the which mediation to take on
day of surgery or which medications to stop taking .
• A final goal is to use the operative experience to
motivate the patient to more optimal health and improved
health outcomes e.g. to encourage patient to stop
smoking before and after their procedures and administer
β-adrenergic receptor .blocking agents to patient at risk
for cardiac complication .
 Question that should be
addressed include the
following :

 Is the patient in optimal health ?

 Can or should the patient’s

physical or mental condition be
improved before surgery ?

 Dose the patient have any health

problems or use any medication
that could unexpectedly influence
preoperative events ?

Upbeat Optimistic Smile

 History :
 The preoperative evaluation should establish the state of health of patient especially their
exercise tolerance their present illness and interactions that have had with their physicians.
 Specific areas that may be investigated in the preoperative history.

01 02 03 04 05 06 07 08 09 10

Allergic Sleep Prolonged Delayed Nausea Hoarseness Myalgia Hemorrhage Jaundice Post - Dural
reaction apnea skeletal awakening and puncture
muscle vomiting headache
paralysis
 Kidney :
•
•
Dialysis dependency History :
Chronic renal filer

Central nervous system :

• Cerebrovascular pressure
Skeletal and muscular • Seizures
system :
• Arthritis
•
Liver :
Osteoporosis
• Alcohol consumption
• Weakness
• Hepatitis
Cardiovascular : Lungs :
• Angina pectoris • Exercise tolerance
• Previous myocardial infarction • Dyspnean and orthopnea
• • Cough and sputum production
Hypertension
• Bronchial asthma
• Rheumatic fever • Cigarette consumption
• Tachydyserhythemia • Pneumonia
• Recent upper respiratory tract infection
History :
Endocrine : Reproductive system :
• Diabetes mellitus. • Menstrual
• Thyroid gland • Pregnancy
dysfunction.
• Adrenal land
dysfunction.

Coagulation history of : Dentition :

• DVT (deep venous • Dentures
thrombosis).
• Bleeding.
 Current drug use and potential interactions with drugs administered in the peril
operative period :
RECOMMENDATIONS

Drugs Adverse Effects

● Antibiotics ● Tolerance to anesthetic debugs.

● Bradycardia .
● Alcohol
● Bronchospasm.
● Impaired sympathetic.
● Nervous system responses.
● Myocardial depression.

● β- antagonists ● Prolongation of the effect of

neuromuscular blocking drugs.
 Current drug use and potential interactions with drugs administered in the peril
operative period :
RECOMMENDATIONS

Drugs Adverse Effects

● Current drug use and potential ● Impaired sympathetic nervous system

interactions with drugs administered in reposes.
the peril operative period.
● Bleeding tendency.
● Antihypertensives.
● Tolerance to anesthetic drugs.
● Aspirin
● Hypotension.
● Benzodiazepines.
● Cardiac dysdrhythemia or conduction
● Calcium channel blockers. disturbances .
 Current drug use and potential interactions with drugs administered in the peril
operative period :
RECOMMENDATIONS

Drugs Adverse Effects

● Diuretics ● Hypokalemia
● Hypovolemia

● Exaggerated responses to
● Monoamine oxidize sympathonimetic drugs if previous
inhibitors treatment was acute

● Exaggerated responses
● Tricycle antidepressants sympathomimetic drugs if pervious
treatment was acute
Per The peroperative physical examination

operative Need to include on evaluation of the :

•
physical Airway

examination the cardiovascular status of the patient.

• Including an assessment of body

massindex systemic blood pressure and
hemaglobin saturation with oxygen and an
examination of the heart and lung .
Per
operative
physical
examination • Optimal peroperative assessment
requires a complete history and
physical examination to
determine whether the patient
has an abnormality that warrants
laboratory tests .
• Specific areas that may be
assessment in peroperative
physical examination :
Central nervous system :
• Level of consciousnss.

• Evidence of peripheral sensory or

skeletal muscle dysfunction.
 Per operative physical examination :

2. Lung 1. Cardiovascular system

• Ausculation of the lung ( rales , • Auscultion of the heart ( heart rate
wheezes) – rhythem murmur ).
• Pattern of breathing . • Systemic blood pressure (supine
• Anatomy of the thorax and standing ).
(emphysema ) .
Veins
3. Upper airway • Veins (access sites).
• Peripheral edema.
• Cervical spine mobility
• Temporomandibular mobility
• Prominent central incisors
• Diseased or artificial teeth 4. Coagulaltion –
• Ability to visualize the uvula
• Thyromental distance
• bruising—
• petechiac
 Anesthesiologists classification of physical status of
patient( ASA) :
Physical status (1) Physical status (2)
Normal health A patient with mild systemic
patient. disease that resalts in no
functional limitations e.g
hypertension , diabetes mellitus
,chronic bronchitis , morbid
obesity , exrames of age.
Physical status (3)
A patient with severe systemic
disease that results in functional
limitation e.g poorly controlled
hypertension , diabetes mellitus
with vascular complications ,
angina pactoris , previous
myocardial infarction , pulmonary
disease that limits activity .
 Anesthesiologists classification of physical status of
Physical status (4)
A patient with severe
systemic disease that is a
constant threat to life e.g –
congestive heart failure ,
unsable angina . advanced
pulmonary , renal or
hepatic dysfunction .
patient( ASA) :
Physical status (5)
moribund patient who is no
expected to survive without the
operation e.g – rupured
abdominal aneurysm –
pulmonary embolus-head
injury with increased
intracranial pressure .
Physical status (6)
-a declared brain –dead patient
whose organs are being removed for
donor purposes. It is useful in
planning anesthesia management –
especially monitoring and
postoperative care) it is also useful in
predicing the morbidity of scheduled
procedure and obtaining informed
consent.
FAMILY HISTORY :

All patient should be asked whether any family

members have experienced problems with
anesthesia for a history of prolonged apnea and
management of hyperpyrexia .

Elective surgery should be postponed if any

conditions are identified while the patient is being
investigated appropriately .

In emergency situation anesthesia must be

adjusted accordingly for e.g by avoiding
triggering drugs in a patient with a potential or
actual family history of malignant hyperpyrexia.
 Drug history
and
allergies :

1. Identify all medications both prescribed and over the counter OTC .including
complementary and alternative medicines and hormone replacement therapy HRT.

2. Unless specifically asked on the whole the number of medication patients take rises
with age .many commonly prescribed drugs such as angiotensin converting enzyme
inhibitors –can have important effects during anesthesia –allergies to the drugs latex
.topical preparation e.g iodine and food stuffs should be noted .
 Smoking –
Social history :

ascertain the amount of tobacco

smoked . this is usually calculated as
number of pack – . Multiplied by the
number of years smoked, this gives
an idea of the total amount smoked .
In the long term smoking causes
chronic lung disease and carcinoma .
but it also has number of other of
important effect relevant to the
preoperative period it produces
carbon monoxide . which stimulates
the sympathetic nervous system –
causing tachycardia – hypertension
and coronary artery narrowing.
SOCIAL HISTORY :

Alcohol :
this is measured as units consumed
per week50 unit. Causes induction
of liver enzymes and tolerance to
anesthetic drugs . The risk of
alcohol withdrawal syndrome
postoperatively must be
considered .
Drugs :
Ask specifically about the use of drug for recreational
purposes .including type .frequency and route of
administration.
This group of patients is as risk of infection with hepatitis
B and human immunodeficiency virus HIV venous access
following I.V drug abuse due to widespread thrombosis
of vines withdrawal syndromes can occur postoperatively.

Pregnancy :
The date of the last  The anesthetist may be the only person in theater able to
menstrual period should be give this information if x-rays are required . anesthesia
noted in all woman of child
increases the risk of inducing a spontaneous abortion in
bearing age
early pregnancy .
OBTAINING INFORMED CONSENT
● What is consent ?
● Consent is an agreement by the patient to undergo a specific procedure.
● Event through the doctor will advise on what is required . it is only the patient who can make
the decision to undergo the procedure although the need for consent is often through of as
applying to surgery.
● It is fact required for any breach of a patient‘s personal integrity including :
examination – performing investigation and giving an anesthetic touching .
● A patient without consent may lead to a claim of buttery .
● For a patient to have the capacity to give consent there are prerequisites the should :
● Understanding what is being proposed its purpose and wee it is being proposed.
● Understand the benefits risks and any alternative .
● Understand the consequences of not receiving what is being proposed .
 THANK YOU
Design / Kholood Al - Naqeeb