Preanesthetic assessment (also called preanesthesia evaluation or pre-op evaluation) is a final medical evaluation conducted by an anesthesia provider before a

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

medical procedure A medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagnosis, diagnosing a patient condition or parameter is also called a medi ...

to ensure

anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

can be administered safely. The anesthesia team ( Anesthesiologists, Certified Registered Nurse Anesthetists or Certified Anesthesia Assistants) reviews the patient’s

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is a set of information the physicians collect over medical interviews. It involves the patient, and ev ...

, medications, past anesthesia experiences and obtains consent. A personal interview is usually conducted with the patient by the anesthesia provider to verify medical history details and address any questions or concerns. The anesthetic plan is then tailored to maximize the patient's safety. Finally, the patient must sign an

informed consent Informed consent is an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative treatme ...

form acknowledging they were informed of risks of anesthesia.

Medical history review

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

Pacemaker A pacemaker, also known as an artificial cardiac pacemaker, is an implanted medical device that generates electrical pulses delivered by electrodes to one or more of the chambers of the heart. Each pulse causes the targeted chamber(s) to co ...

s or

bleeding disorders Coagulopathy (also called a bleeding disorder) is a condition in which the blood's ability to coagulate (form clots) is impaired. This condition can cause a tendency toward prolonged or excessive bleeding ( bleeding diathesis), which may occur s ...

: These conditions may influence anesthesia choices. * Higher risk of nausea:

Postoperative nausea and vomiting Postoperative nausea and vomiting (PONV) is the common complication of nausea, vomiting, or retching experienced by a person within the first 24 hours following a surgical procedure. Untreated, PONV affects about 30% of people undergoing general an ...

(PONV) is more common in female patients, particularly younger individuals. * Past anesthesia complications: Difficulty with

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ...

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. * Addressing

Anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

: Providing information about the procedure can help ease concerns. * Discussing Anesthesia Options: Determining whether general or

regional anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. It all ...

is most appropriate with the patient's preferences in mind. *

Jewelry Jewellery (or jewelry in American English) consists of decorative items worn for personal adornment such as brooches, ring (jewellery), rings, necklaces, earrings, pendants, bracelets, and cufflinks. Jewellery may be attached to the body or the ...

or Piercings: Removal is often required to prevent complications. A metal piercing could cause a severe burn if electrocautery is used during surgery. * Uncontrolled Medical Conditions: Uncontrolled blood sugar or

blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...

may need management before the surgical case. * Religious Considerations: Some patients, such as

Jehovah’s Witnesses Jehovah's Witnesses is a Christian denomination that is an outgrowth of the Bible Student movement founded by Charles Taze Russell in the nineteenth century. The denomination is nontrinitarian, millenarian, and restorationist. Russell co- ...

, may decline

blood transfusion Blood transfusion is the process of transferring blood products into a person's Circulatory system, circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used ...

s, and this should be clarified with the anesthesia provider. Those of the Muslim faith may have specific requests in terms of physical contact. * 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 can significantly increase the risk of aspiration (stomach contents entering the lungs), which can lead to serious complications, including the need for

intensive care Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes p ...

. Normal muscle function returns once anesthesia has worn off, and the patient is transferred to the post-anesthesia recovery unit. * Confirming the Surgical Plan: An extra safety measure to verify all necessary details. Medications: *

Diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

: Adjustments to insulin or other medications may be necessary. Certain drugs, such as

GLP-1 Glucagon-like peptide-1 (GLP-1) is a 30- or 31-amino-acid-long peptide hormone deriving from tissue-specific posttranslational processing of the proglucagon peptide. It is produced and secreted by intestinal enteroendocrine L-cells and certai ...

and

SGLT2 inhibitor SGLT2 inhibitors (also called gliflozins or flozins) are a class of medications that inhibit sodium-glucose transport proteins in the nephron (the functional units of the kidney), unlike SGLT1, SGLT1 inhibitors that perform a similar function in ...

s, 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 An anticoagulant, commonly known as a blood thinner, is a chemical substance that prevents or reduces the coagulation of blood, prolonging the clotting time. Some occur naturally in blood-eating animals, such as leeches and mosquitoes, which h ...

: Medications like

aspirin Aspirin () is the genericized trademark for acetylsalicylic acid (ASA), a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and inflammation, and as an antithrombotic. Specific inflammatory conditions that aspirin is ...

warfarin Warfarin, sold under the brand name Coumadin among others. It is used as an anticoagulant, anticoagulant medication. It is commonly used to prevent deep vein thrombosis and pulmonary embolism, and to protect against stroke in people who ha ...

may need to be paused before surgery. * Herbal Supplements: Some natural remedies can affect blood clotting or interact with anesthesia. *

Seizure A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...

Medications: Certain epilepsy drugs are sometimes held before surgery, depending on the procedure.

Physical exam

* 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 to look up at the ceiling. * Lung Health: Conditions such as

asthma Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wh ...

sleep apnea Sleep apnea (sleep apnoea or sleep apnœa in British English) is a sleep-related breathing disorder in which repetitive Apnea, pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor vent ...

, or

smoking Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

history can impact breathing under anesthesia. Frequently, a preoperative

chest x-ray A chest radiograph, chest X-ray (CXR), or chest film is a Projectional radiography, projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common fi ...

is performed to ensure readiness for possible ventilatory support during surgery. * Heart Health: Surgery can be considered to be as stressful as walking up 1-2 flights of stairs. The inability to tolerate such exertion may require modifications to the anesthetic plan. Sometimes, a 12-lead EKG may be necessary to ensure a patient's heart is ready. In select cases a more in-depth test called a

transthoracic echocardiogram A transthoracic echocardiogram (TTE) is the most common type of Echocardiography, echocardiogram, which is a still or moving image of the internal parts of the heart using ultrasound. In this case, the probe (or ultrasonic transducer) is placed on ...

(ultrasound of the heart) is also performed. * Physical Limitations and Frailty: Issues with mobility, stiff joints, or other conditions may affect positioning during surgery. These challenges tend to be more common for the elderly who require up to four times the number of surgical procedures.

Intravenous access

Before a patient is taken to the operating room, an anesthesia provider verifies the number and size of intravenous ( IV) catheters required for the procedure. IV access is essential for administering fluids,

medications Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

, and life-saving blood products. In many cases, two IV catheters are placed as a precaution in case one fails during the procedure. Larger-bore IVs may be necessary to accommodate high-volume fluid administration. For patients with allergies to inhaled anesthetics, anesthesia can sometimes be administered exclusively through an IV. In cases where IV access is challenging due to patient-specific factors,

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

guidance may be used to facilitate catheter placement.

Consent for anesthesia

There are many details to be covered before anesthesia is provided. The information covered and how depends on the needs of the patient. If available, the anesthetist may offer different options for pain control during and after surgery. Adverse effects of anesthesia and need for possible admission to the intensive care unit (ICU) are discussed. Patients have the opportunity to ask questions and make decisions to guide their care.

Anesthesia students

mnemonic A mnemonic device ( ), memory trick or memory device is any learning technique that aids information retention or retrieval in the human memory, often by associating the information with something that is easier to remember. It makes use of e ...

has been suggested for pre-anesthetic assessment, to ensure that all aspects are covered. It runs

alphabet An alphabet is a standard set of letter (alphabet), letters written to represent particular sounds in a spoken language. Specifically, letters largely correspond to phonemes as the smallest sound segments that can distinguish one word from a ...

ically: :A – Affirmative history;

Airway The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory ...

:B – Blood

hemoglobin Hemoglobin (haemoglobin, Hb or Hgb) is a protein containing iron that facilitates the transportation of oxygen in red blood cells. Almost all vertebrates contain hemoglobin, with the sole exception of the fish family Channichthyidae. Hemoglobin ...

, blood loss estimation, and blood availability;

Breathing Breathing (spiration or ventilation) is the rhythmical process of moving air into ( inhalation) and out of ( exhalation) the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxy ...

:C – Clinical examination; Co-morbidities :D –

Drugs A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via inhalation, injection, smoking, ingestio ...

being used by the patient; Details of previous anesthesia and surgeries :E – Evaluate investigations; End point to take up the case for surgery :F – Fluid status;

Fasting Fasting is the act of refraining from eating, and sometimes drinking. However, from a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (before "breakfast"), or to the metabolic sta ...

:G – Give physical status; Get

consent Consent occurs when one person voluntarily agrees to the proposal or desires of another. It is a term of common speech, with specific definitions used in such fields as the law, medicine, research, and sexual consent. Consent as understood i ...

References

{{reflist Surgery Medical mnemonics Anesthesia