PREOPERATIVE

ASSESSMENT
& PREPARATION
WILLIAM ADDISON
NURSING/MIDWIFERY 2024

Slide 1
OBJECTIVE

 Why the need for preoperative

assessment
 How to perform a simple
preoperative anaesthetic
assessment
 Categorize patient’s risk of
anaesthesia and surgery
Slide 2
 AIM

 Establish rapport
 Evaluate patient’s overall health status
 Anticipation of possible complications
 Confirm anticipated benefits outweigh risks
 Ensure optimization of patient condition
 Plan anaesthetic technique
 Adequate preparation both logistics &
personnel
 Patient education & consent
Slide 3
 Premedication
 HISTORY

 Confirm identity, type, site & duration of

surgery
 Past anaesthetic Hx
 Type, when
 Complications: Delayed recovery, PONV,
difficult intubation, etc
 Chronic illness
 Family
Slide 4
 DRUGS:
 Allergy
 Social: smoking, alcohol, illicit drugs
 Organ damage
 Withdrawal symptoms
 Dose of anaesthetic

Slide 5
 EXAMINATION


General

 CVS

 Respiratory

 Airway

 Nervous
Slide 6
 Others
 AIRWAY ASSESSMENT

 Hx
 Thick short neck
 Stiffness of cervical spine
 Limited mouth opening
 Growth in the oropharynx, airway
 Neck mass
 Receding chin
 deviation of the trachea
Slide 7
 Mallampati score III, IV
 Mallampati Score

Slide 8
 INVESTIGATIONS

 FBC
 HB electrophoresis
 Urine
 urea, creatinine, electrolytes
 Liver Function test
 Coagulation profile
 Radiological
 ECG: known cardiovascular risk
 OTHERS:

Slide 9
 ASA CLASSIFICATION

ASA DEFINITION EXAMPLES

ASAI Healthy Healthy, non-smoking, no or minimal alcohol
patient
ASA Patient with Current smoker, social alcohol drinker,
II mild systemic obesity (<40), well-controlled HPT/DM,
disease normal pregnancy, controlled PIH
ASA Patient with MI, CVA (>3months), alcohol dependence,
III severe poorly controlled HPT/DM, BMI≥40, ESKD on
systemic regular scheduled dialysis,
disease Pre-eclampsia, premature neonate, term
infant less than 6wks, difficult airway

Slide 10
 ASA CLASSIFICATION

ASA DEFINITION EXAMPLES

ASAIV A patient with severe Recent (<3months) MI, CVA, ESKD not on
systemic disease that regular dialysis, sepsis, DIC, Pre-eclampsia
is a constant threat to complicated by HELLP syndrome or eclampsia,
life shock, DIC, severe respiratory distress,
advanced oncologic state
ASA V • A moribund patient Ruptured thoracic/abdominal aneurysm, massive
who is not trauma, intracranial bleed with mass effect,
expected to survive ischaemic bowel disease with cardiac pathology
24h without surgery or multiple organ dysfunction
Uterine rupture

ASA VI • Brain stem dead

patient whose
organs are being
removed for donor
purposes
Slide 11

Add E to denote emergency eg ASA IIE

 POSTPONING SURGERY

Fitness for anaesthesia depends on a lot of factors including

urgency of surgery.
Final decision between surgeon, anaesthetist & the patient

 Acute Upper airway Infection

 Uncontrolled co-morbidity
 Inadequate resuscitation
 Recent Ingestion of food
 drugs
 consent
Slide 12
 PREPARATION

Personnel
Space
Equipment
Drugs
consent

Slide 13
 FASTING GUIDELINES

Minimum fast period

Clear Fluids : 2hours

Breastmilk: 4hrs
Solid food, non-human milk:6hrs
Factors affecting gastric emptying
 Raised intra-abdominal pressure, DM,
Pregnancy
Slide 14
 PREMEDICATION

Adm of drugs 1-2hrs before induction

 allay anxiety and fear
 reduce postoperative nausea and vomiting
 reduce gastric volume and increase the pH of
gastric contents
 Others: against specific conditions

Slide 15
 THANK YOU

Slide 16