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Aishah Awatif Haziq. Pre-operative evaluation and preparation (prior to procedure under general anesthesia). Introduction . Anaesthesia = absence of all sensation Analgesia = absence of pain

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Aishah awatif haziq




Pre-operative evaluation and preparation (prior to procedure under general anesthesia)


  • Anaesthesia = absence of all sensation

  • Analgesia = absence of pain

  • General anaesthesia = a state where all sensation is lost and the patient is rendered unconscious by drugs.

  • GA should be performed by qualified anasthetists in a hospital setting with access to appropriate medical support.

Assessment of risk
Assessment of risk

  • Patient should be made as fit as possible for the operation.

  • The anticipated benefit should outweigh the anesthetic and surgical risks involved.

  • Overall mortality rate ≈ 1 in 100 000

  • Surgical mortality ≈ 1 in 1000

  • Factors contribute to this mortality:

    • Poor preoperative assessment

    • Inadequate supervision and monitoring in the intraoperative period

    • Inadequate postoperative care

Aims of pre operative evaluation and preparation
Aims of Pre-operative evaluation and preparation

  • To provide diagnostic & prognostic information.

  • To ensure the patient understands the nature, aim, and expected outcome of surgery.

  • To relieve anxiety and pain.

  • Ensure that the right patient gets the right surgery.

  • Get informed consent.

  • Assess/balance risks of anaesthesiaans maximize fitness.

  • Check anaesthesia/analgesia type with anesthesia.


  • Past medical history:

    • Asthma

    • Diabetes

    • Tuberculosis

    • Seizures

    • Chronic organ dysfunction

    • HIV infection

    • Drug allergy

    • DVT

    • Post-operative nausea and vomiting

Drug history
Drug history

  • Drug interactions

    • Anticoagulant might be contraindicated to spinal, epidural or other regional techniques

    • Anticonvulsants might increase the requirements for anasthetic agents, enflurane should be avoided as it might precipitate seizures

    • Beta-blockers – negative ionotropic effect – hypotension

Social history
Social history

  • Ceasing smoking 12h before surgery can improve the oxygen carrying capacity of the blood.

  • Excessive alcohol – hepatic and cardiac damage

Family history
Family history

  • Hereditary traits:

    • Haemophilia

    • Porphyria

    • Cholinesterase abnormalities – prolongation of muscle relaxants such as suxamethonium

Physical examination
Physical examination

  • Assess cardiorespiratory system, exercise tolerance, existing illness, drugs, and allergies.

  • Is the neck unstable (eg; arthritis complicating intubation?)

  • Assess past history of; MI, diabetes, asthma, hypertension, rheumatic fever, epilepsy, jaundice.

  • Assess any specific risk, eg is the patient pregnant? Is the neck/jaw immobile and teeth stable (intubation risk)?

Indications of preoperative investigations

  • Full blood count

    • anaemia

    • females post menarche

    • cardiopulmonary disease

    • possible haematological pathology, e.g.

    • haemoglobinopathies

    • likelihood of significant intraoperative blood loss

    • history of anticoagulants

    • chronic diseases such as rheumatoid disease

  • Clotting screen

    • liver disease

    • anticoagulant drugs or a history of bleeding or

    • bruising

    • kidney disease

    • major surgery

  • Urea and electrolyte concentrations

    • major surgery >40 years

    • kidney disease

    • diabetes mellitis

    • digoxin, diuretics, corticosteroids, lithium

    • history of diarrhoea and vomiting

  • Liver function tests: these will be carried out when there

    • is any suspicion of liver disease

  • ECG

    • >40 years asymptomatic male or >50 years asymptomatic female

    • history of myocardial infarction or other heart or vascular disease

    • <40 years with risk factors e.g. hyperlipidaemia, diabetes mellitus, smoking, obesity, hypertension and cardiac medication

  • Chest radiography

    • breathlessness on mild exertion

    • suspected malignancy, tuberculosis or chest infection

    • thoracic surgery

Pre op therapy
Pre-op therapy

  • Pt with respiratory disease – physiotherapy or bronchodilator therapy

  • Infective endocarditis – prophylactic antibiotic

  • Hypertension – adjustment of drug therapy to obtain optimal control (diastolic pressure below 110 mmHg)

Postponement of surgery
Postponement of surgery

  • Pt with acute upper resp tract infection

  • Cardiac/endocrine diseases that are not yet under optimal control

  • Elective surgery should not be undertaken unless:

    • Pt has fasted for 6h for solid food, Infant formula or other milk

    • 4h for breast milk

    • 2h for clear non-particulate and non-carbonated fluids

Pre medication

  • benzodiazepines – anxiolysis, anterograde amnesia

  • Anticholinergic drug – reduce excessive secretions in the airway

  • Antiemetic

  • Antihistamine

  • Metoclopramide - enhance gastric emptying

  • Sodium citrate, H2 blockers, proton pump inhibitor – reduce gastric acidity

Preparation for anesthesia
Preparation for anesthesia

  • Fast patient.

    • Nil by mouth ≥ 2h pre-op for clear fluid and ≥ 6h for solids

  • Is there any bowel or skin preparation needed, or prophylactic antibiotic?

  • Start DVT prophylaxis as indicated, eg: graduated compression stockings + heparin 5000U sc 2h pre-op, then every 8-12h sc for 7d or until ambulant.

  • Write up the pre-meds; book any pre-, intra-, or post-operative x-rays or frozen sections. Book post-op physiotherapy.

  • If needed, catheterize and insert Ryle’s tube before induction. These can reduce organ bulk, making it easier to operate in the abdomen.