THINGS THE STUDENT NEED TO KNOW

PREOPERATIVE ASSESSMENT
History taking PREOPERATIVE ASSESSMENT
Be able to take a pertinent history, including
1. co-existing disease,
2. previous anesthetic problems,
3. medication,
4. allergies and
5. family history.
Identify important factors which may influence the peri-operative period in
1. patients with respiratory and
2. cardiovascular disease,
3. endocrine abnormalities,
4. obesity and
5. fluid status.
Specific concerns related to patients with (diseases)
1. asthma, COPD,
2. hypertension,
3. angina,
4. diabetes,
5. morbid obesity and
6. hypovolaemia should be considered.
Physical examination PREOPERATIVE ASSESSMENT
Perform an appropriate physical exam including
assessment of the airway,
respiratory and
cardiovascular systems.
Laboratory testing PREOPERATIVE ASSESSMENT
Recognize the appropriate use of laboratory testing and
the need for special investigations.
Recognize the rationale for pre-operative fasting and
drugs which can be given to reduce the morbidity associated with patients at high-risk for aspiration. Identify certain
conditions that place the patient at high risk for aspiration under general anesthesia.
PREOPERATIVE MANAGEMENT
Skills
1. Incorporate the principles of body substance precautions into your practice.
2. Intravenous lines:
a. Be able to select an appropriate vein,
b. assemble IV solution and tubing,
c. use aseptic technique,
d. select an appropriate catheter,
e. perform venipuncture,
f. protect the venipuncture site and verify functioning.
3. Airway and ventilatory management:
a. Be able to use bag and mask to ventilate patient;
b. identify and overcome upper airway obstruction with appropriate movement of cervical spine and
mandible.
c. Use of oropharyngeal airway.
d. Become facile with the use of the laryngeal mask and verify its position.
e. Intubation: Be able to select and prepare appropriate equipment, correct technique to intubate the
trachea, and verify correct placement.
f. Ventilation: Assess adequacy of spontaneous ventilation using physical signs and monitors.
Difficult Airway Assessment
LEMON assessment.
L: Look externally
Assessing the difficulty of an airway based on external physical features is not sensitive (not all patients who have a
difficult airway appear to have a difficult airway prior to intubation) but is quite specific (most patients who appear to
have a difficult airway do indeed have a difficult airway). Physical features such as a small mandible, large tongue,
and short bull neck are all red flags for a difficult airway.
E: Evaluate the 3-3-2 rule
The chance for success is increased if the patient is able to insert 3 of his or her own fingers between the teeth, can
accommodate 3 finger breadths between the hyoid bone and the mentum (see hyomental distance in the first image