Preoperative Evaluation
A preoperative evaluation is a crucial step before surgery to assess a patient's overall health, identify potential risks, and optimize their condition for a safe procedure.
It typically includes:
Medical history: Chronic conditions (hypertension, diabetes, cardiovascular diseases, pulmonary issues, renal disorders, etc.)
Surgical history: Past surgeries, anesthesia-related complications, wound healing issues.
Medications: Anticoagulants, antiplatelets, immunosuppressants, corticosteroids, etc.
Allergies: Medication, latex, or anesthesia-related.
Family history: Malignant hyperthermia, bleeding disorders.
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 Tests (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.