NICE produce a colour traffic light table which can further guide your investigative decisions. For example, elective surgery is often delayed for poorly controlled blood glucose levels in diabetic patients, to allow time for optimisationĮach specific hospital is likely to provide local guidelines, however it is useful to understand the tests than could be done pre-operatively and have an appreciation as to why each may be requested. The urgency of the surgery will also dictate which conditions need further investigation and management prior to surgery. The nature of the exact investigations required depends on a number of factors, including co-morbidities, age, and the nature of the procedure. Living situation, as the absence of an adult at home may require an admission overnight.Language spoken and the need for an interpreter.Other important social factors to make note of include: Whilst most hereditary conditions relating to anaesthesia are extremely rare, such as malignant hyperthermia, it is important to ask about any known family history of problems with anaesthesiaĮnsure to ask the patient about smoking history, alcohol intake, and any recreational drug use Ask about any known allergies, both drug and non-drug allergies Has the patient had anaesthesia before? If so, for what operation and what type of anaesthesia? Were there any problems? Did the patient experience any post-operative nausea and vomiting?Ī full drug history is required, as some medications require stopping or altering prior to surgery. If the patient is having a repeat procedure, this can significantly change both the surgical time and ease of operation, and hence influence the anaesthetic technique used Has the patient had any previous operations? If so, what, when, and why? Sickle Cell Disease – could they have undiagnosed sickle cell disease, especially if their country of birth does not have routine screening for sickle cell.Pregnancy – as part of the pre-operative checklist on the day of surgery, for females of reproductive age a urinary pregnancy test is mandatory in the majority of hospitals.Other specific questions it may be useful to ask themselves the following questions: Whilst this may be overlooked as a diagnosis or in their past medical history, particularly if patient managed with over-the-counter medicines, it is important to ask about at the pre-operative assessment.Gastro-oeseophageal reflux ( GORD), as the aspiration of gastric contents can potentially be fatal and the presence of GORD will likely alter anaesthetic technique.Endocrine disease, specifically diabetes mellitus and thyroid disease.Renal disease, including their baseline renal function and any renal-specific medications. ![]() Questions including whether the patient is able to lie flat for a prolonged period or has a chronic cough are key as these may preclude spinal anaesthesia also screen for symptoms and signs of obstructive sleep apnoea, if the patient has any risk factors.Respiratory disease, as adequate oxygenation and ventilation is essential in reducing the risk of acute ischaemic events in the peri-operative period.the presence of exertional chest pain, syncopal episodes, or orthopnoea Screening questions may elucidate undiagnosed disease and prompt further investigation, e.g. ![]() ![]() Cardiovascular disease, including hypertension exercise tolerance is a useful indicator of cardiovascular fitness and, particularly for patients undergoing major surgery, can help predict their risk of post-operative complications and level of care needed post-operatively.There may be aspects of the disease or condition requiring surgery that are important for the anaesthetist to be aware of for example, head and neck surgery may indicate the presence of abnormal airway anatomy.Ī full past medical history (PMH) is required, with the following specifically asked about: One should also confirm the side on which the procedure will be performed (if applicable) The pre-operative history follows the same structure as typical history taking, with the addition of some anaesthetic and surgery specific topics.Ī brief history of why the patient first attended and what procedure they have subsequently been scheduled for. In this article, we shall look at the components of an effective pre-operative history, examination, and routine investigations that can be performed. Patients scheduled for elective procedures will generally attend a pre-operative assessment 2-4 weeks before the date of their surgery. ![]() The pre-operative assessment is an opportunity to identify co-morbidities that may lead to patient complications during the anaesthetic, surgical, or post-operative period.
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