Preoperative Evaluation [Neurosurgery Wiki]

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=====Preoperative Evaluation=====

[[Preoperative Planning]].
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A [[preoperative]] [[evaluation]] is a crucial [[step]] before surgery to assess a patient's [[overall health]], identify potential [[risk]]s, and optimize their condition for a safe procedure. 

It typically includes:

1. [[Patient History]]

[[Medical history]]: Chronic conditions (hypertension, diabetes, cardiovascular diseases, pulmonary issues, renal disorders, etc.)

[[Surgical history]]: Past surgeries, anesthesia-related complications, wound healing issues.

[[Medication]]s: Anticoagulants, antiplatelets, immunosuppressants, corticosteroids, etc.

Allergies: Medication, latex, or anesthesia-related.

[[Family history]]: Malignant hyperthermia, bleeding disorders.

[[Social history]]

2. [[Physical Examination]]

General assessment: Vital signs, BMI, signs of infection.

Cardiovascular system: Auscultation for murmurs, arrhythmias, peripheral pulses.

Respiratory system: Airway assessment (Mallampati score), lung sounds.

Neurological status: Baseline cognitive function, deficits.

Local examination: Site of surgery, skin integrity, presence of infection.

3. Laboratory and [[Diagnostic Test]]s (as indicated)

Basic bloodwork: CBC, electrolytes, renal and liver function tests.
Coagulation profile: INR, PT, aPTT.
Blood glucose: Especially for diabetic patients.
ECG: For patients with cardiac risk factors.
Chest X-ray: If respiratory disease is suspected.
Other specialized tests: Echocardiogram, stress test, pulmonary function tests if needed.

4. Risk Assessment (Scoring Systems)

ASA Classification: American Society of Anesthesiologists Physical Status classification.
Revised Cardiac Risk Index (RCRI): To assess perioperative cardiac risk.
Caprini Score: Venous thromboembolism (VTE) risk.
STOP-BANG Score: For obstructive sleep apnea screening.

5. Anesthesia Evaluation

Type of anesthesia (general, regional, local).
Airway assessment (difficult airway predictors).
Postoperative pain management plan.

6. Optimization and Preoperative Instructions

Medication adjustments: Discontinuation or modification of anticoagulants, beta-blockers, etc.
NPO (Nil Per Os) guidelines: Typically 6-8 hours before surgery.
Prehabilitation: Physiotherapy, smoking cessation, glycemic control.
Informed consent: Risks, benefits, alternatives.