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Preanesthetic Assessment

The preanesthetic assessment is a final medical evaluation conducted by an anesthesia provider before a surgery or procedure to ensure anesthesia can be administered safely. The anesthesia team (Anesthesiologists, Certified Registered Nurse Anesthetists or Anesthesia Assistants) reviews the patient’s medical history, medications, and past experiences with anesthesia to minimize risks and prevent complications. They will then tailor the anesthetic plan to maximize patient safety.

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Locations for Preanesthetic Assessments

The assessment can take place in different settings:

• Preoperative Clinic: Some patients visit a dedicated clinic days or weeks before surgery for a thorough evaluation by the anesthesia team.
• Immediately Before Surgery: If a separate visit is not required, the anesthesia team conducts the assessment on the day of surgery, usually in the preoperative area of the hospital.

Reviewing Medical History

A review of the medical chart helps identify any risk factors that could impact anesthesia, including:

• Pacemakers or bleeding disorders: These conditions may influence anesthesia choices.
• Higher risk of nausea: Postoperative nausea and vomiting (PONV) is more common in female patients, particularly younger individuals.
• Past anesthesia complications: Difficulty with intubation or excessive nausea after previous surgeries should be noted.

Patient Interview

A face-to-face discussion with the anesthesia provider helps ensure all necessary precautions are taken. This process includes:

• Addressing Anxiety: Providing information about the procedure can help ease concerns.
• Confirming the Surgical Plan: An extra safety measure to verify all details.
• Discussing Anesthesia Options: Determining whether general or regional anesthesia is most appropriate.

Key Topics Addressed

• Physical Limitations: Issues with mobility, stiff joints, or other conditions that may affect positioning during surgery.
• Airway and Lung Health: Conditions such as asthma, sleep apnea, or smoking history can impact breathing under anesthesia.

• 

  Airway assessment

  Airway Evaluation: The anesthesia provider may use the Mallampati score or other tools to predict potential intubation difficulties.  This occurs when the anesthesia provider asks patients to open their mouths widely for inspection.  They may also ask the patient to turn their head side to side or they can look up at the ceiling.
• Jewelry or Piercings: Removal is often required to prevent complications. A metal piercing could cause a severe burn if electrocautery is used during surgery.
• Medications:
  • Diabetes: Adjustments to insulin or other medications may be necessary.  Certain drugs, such as GLP-1 and SGLT2 inhibitors, may require special instructions.  These medications can prevent the stomach from emptying out normally, seriously increasing the risk of choking on stomach contents when a breathing tube is inserted and removed.
  • Blood Thinners: Medications like aspirin or warfarin may need to be paused before surgery.
  • Herbal Supplements: Some natural remedies can affect blood clotting or interact with anesthesia.
  • Seizure Medications: Certain epilepsy drugs are sometimes held before surgery, depending on the procedure.
• Religious Considerations: Some patients, such as Jehovah’s Witnesses, may decline blood transfusions, and this should be discussed with the anesthesiologist in advance.

Common Reasons for Surgery Delays or Cancellations

• Eating or Drinking Before Surgery: Failure to follow NPO (nothing by mouth) guidelines may postpone surgery for safety reasons. Anesthesia medications can temporarily impair the muscles responsible for keeping food and liquids in the stomach. Consuming food or liquids beyond the instructed time significantly increases the risk of aspiration (stomach contents entering the lungs), which can lead to serious complications, including the need for intensive care. Normal muscle function returns once anesthesia has worn off, and the patient is transferred to the post-anesthesia recovery unit.
• Uncontrolled Medical Conditions: Elevated blood sugar or high blood pressure must be managed before proceeding.
• Medication Timing Issues: Certain drugs, including some epilepsy and blood thinner medications, may need adjustment before surgery.

Tests and Lab Work

Preoperative testing is performed based on medical history and risk factors, including:

• Blood Tests: Platelet levels and other factors are checked to ensure proper clotting.
• Heart Tests (EKG): An electrocardiogram (EKG) may be required for patients with heart conditions.
• Electrolyte Levels: Abnormal potassium levels must be corrected before surgery.
• Pregnancy Testing: Routine for female patients of childbearing age.
• Blood Typing: Necessary in case a transfusion is required.
• Additional Testing: In some cases, lung function tests or imaging studies may be necessary for patients with underlying respiratory or cardiac conditions.

Special Considerations for Different Patient Groups

• Pediatric Patients: Children may require different anesthesia doses and techniques. The assessment may include a discussion of fasting times and the presence of caregivers during induction.
• Geriatric Patients: Older adults may have unique medication sensitivities and medical conditions requiring tailored anesthesia plans. Additional heart or kidney function tests may be needed.

Anesthesia Consent Form

Before surgery, an anesthesia consent form must be signed, acknowledging an understanding of the risks and benefits of anesthesia. The form typically includes:

• The type of anesthesia planned.
• Potential risks, such as nausea or rare complications.
• Special considerations based on individual health conditions.d

References

COPIED FROM ORIGINAL ARTICLE FOR REFERENCE Copied from original Article Preanesthetic assessment (also called preanesthesia evaluation, pre-anesthesia checkup (PAC) or simply preanesthesia) is a medical check-up and laboratory investigations done by an anesthesia provider or a registered nurse before an operation, to assess the patient's physical condition and any other medical problems or diseases the patient might have. The goal of the assessment is to identify factors that significantly increase the risk of complications, and modify the procedure appropriately. The aim is to identify the appropriate anesthetic techniques to be used, to ensure the safety of perioperative care, optimal resource use, improved outcomes, and patient satisfaction, while considering the individual and person related risk factors and circumstances. The preanesthetic assessment involves the consideration of information from various sources that include the past medical records, interview, physical examination, as well as results from medical and laboratory tests.