PREOPRATIVE ASSESSMENT

AIMS OF PREOPERATIVE ASSESSMENT:

Confirm that surgery proposed is realistic when comparing the likely benefits to
the patient with possible risks involved.
Anticipate potential problems.
Ensure adequate facilities and appropriately trained staff available.
Ensure patient is prepared correctly for the operation
Provide appropriate information to patient and obtain consent.
Prescribe premedication and specific prophylactic measures if needed
Ensure proper documentation of assessment process.

PREOPERATIVE FEATURES SES PERIOPERATIVE COMPLICATIONS OR

MORTALITY
DEMOGRAPHIC/ SURGICAL: 1- Dyspnea @ rest or on minimal
1. Age >70 years exertion
2. Major thoracic, abdominal, 2- MI < 6 months previously
Cardiovascular surgery
3- Cardiac surgery requiring treatment
3. Perforated viscous
4. Intestinal obstruction 4- Confusion state
5. Palliative surgery 5- Clinical jaundice
6. Smoking 6- Significant wt loss > 10% in 1
7. Cytotoxic and corticosteroid month
treatment 7- Cough with sputum especially if
8. DM persistent.
8- Hemorrhage or anemia requiring
PHYSIOLOGIAL: transfusion

Laboratory Clear fluids -> 2 hours

Plasma urea >20 mmoles/L Breast milk ->4 hours
Serum Albumin<30 g/l Light meal, infant formula and other
Hb < 10 g/L milk -> 6 Ho
Fatty or fried food -> 8 hours
Fasting:

1
Dr. Tariq Mahar
OBJECTIVES OF PREMEDICATION:
1. Allay anxiety and fear
2. Reduce secretions.
3. Enhance the hypnotic effects of general anesthetic agents
4. Reduce postoperative nausea and vomiting
5. Produce amnesia
6. Reduce volume and increase PH of gastric contents.
7. Attenuate vagal reflexes
8. Attenuate sympathomimetic responses

ASA CLASSIFICATION:
Class I A normal healthy individual.
Class II A patient with mild systemic disease.
Class III A patient with severe systemic disease that is not incapacitating.
Class IV A patient with incapacitating disease that is a constant threat to life
Class V A moribund pt not expected to survive 24 hrs with or without
operation
Class E Added as a suffix for emergency surgery.

INDICATIONS FOR INHALATIONAL INDUCTION:

1. Young children
2. Upper airway obstructions e.g. epiglottitis
3. Lower airway obstruction with foreign body
4. Bronchopleural fistula or empyema
5. No accessible veins

2
3