PRE ANESTHESIA MANAGEMENT

AND PREMEDICATION

Dr. Santosh Khadka

Assistant Prof
NAIHS
2073/11/26

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 What we are covering?
Definition
Aim
History taking
Examination: general/ systemic/airway
Investigations: routine / esp.
ASA Grading (Risks analysis )
Modification in pre-existing medical Rx
Optimization & Planning
Premedication
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 Definition :
The process of clinical assessment that
precedes the delivery of anesthesia care for
surgery or non surgical procedures.

PAC consists of the consideration of

information from multiple sources: include
the Pts. Interview, Medical records, Physical
examination & finding from medical tests and
evaluation.
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 Aim
To obtain brief medical and surgical history

To perform examination and needed Invs.

To reduce anxiety and educate the pts.

about anesthesia .

To make a rapport with pt.

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 To identify the risk of anesthesia and surgery
(ASA grading )& optimization of risk factor

To obtain informed written consent

To plan anesthetic technique

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 History
Demographic details

Regarding surgery

Co morbidities

Routine medication
Allergy
Personnel habits 6
 Previous anesthesia exposure.

Family history

Airway & spine

Last oral intake / NPO time

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 Examination
General & Physical- vital signs, JALCCOD

Systemic CVS ,RESP,NERVOUS & others

Airway MPG,TOOTH, TMJ,THYROMENTAL

DISTANCES, NECK MOVEMENT, TRACHEAL
POSITION
Esp. Spine , Regional areas & veins

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 Respiratory system-
Chest movement &deformities,
Rate
Auscultation
Special examination: Breath holding time,
Match stick test, PFT
( COPD, LUNG ABCESS, INTERSTITIAL
PERENCHYMAL LUNG DISEASE, EFFUSION)

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 Cardiovascular System:
Heart rate& rhythm, BP, Neck veins
Auscultation
( HTN, Valvular Heart Disease, IHD, Failure, AF
& Blocks, Interventions)

CNS-
Epilepsy, ICP, Motor &Sensory Disorders

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 Endocrine :
DM- Types, duration& sign of Neuropathy,
PRIDICT DIFFICULT AIRWAYS
Thyroid- hypo or hyper

Adrenal-

Parathyroid-

Pituitary-
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 Hepatobiliary

Gastrointestinal

Renal

Musculoskeletal

Hematology & Immune system

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 Airway Examination
History- Past anesthetic exposure
Examination Pts. Features:
Faces, Necks, Mouth opening,
Teeth, Tongue
Thyromental distances
TMJ
Mallampati grading

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 Mallampati grading: On 1985 . Pt. keep on
same level of examiner neutral position with
max. mouth opening with protruding tongue
out side: faucial pillar, soft palate, uvula.

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 Investigations
Screening routine investigations:

To identification & discovery of disease or

disorders

To verification or assessment of already

known disease

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 Normally ASA I Pts. Below 40 yrs- CBC,
URINE R/E .

ASA II Or Above 40 yrs CBC, Blood

Biochemistry, ECG, CXR & other needed INVs

Special INVs- ECHO, PFT, TMT, TFT, ABG,

special Images

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 Preoperative status
Risk analysis :
ASA grading
P1- A normal healthy Pt.

P2- A pt. with mild systemic disease

P3- A Pt. with moderate to severe systemic

disease having functional limitation
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P4- A Pt. with severe systemic disease having
functionally incapacitate that constant threat
to life.

P5- A moribund Pt. who is not expected to

survive with or without operation.

P6- Brain dead Pts. (organ donation)

Prefix E- emergency.
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 Modification in pre existing medical
therapy
To be continued or stopped

New medication when required

Anti hypertensive drugs, Insulin, OHG, Anti

platelets , Anticoagulants, anti depressants,
Anti epileptics , Steroids, Antibiotics

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 Optimization & Planning
After optimization of Pt. before operation
will minimizing morbidities & mortalities
And improves peri & post operative care.

Anesthesia counseling: Possible details about

anesthesia & obtaining written informed
consent.

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 Anesthesia Plan
NPO Hours before surgery
Adult - Child / Solid liquid food
Types of anesthesia:
G/A Induction, Airway,
Maintenance, Muscle relaxant
REGIONAL- Techniques, agents,
MAC- Monitoring, sedation

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 Intraoperative Mx-
Monitoring, positioning, fluid mx, special
techniques

Post operative Mx-

Pain control, Intensive care, Mechanical
ventilation

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 PREMEDICATION
To reduce anxiety

To produce hemodynamic stability

To induce sedation & decrease metabolic rate

To provide analgesia

To provide retro-grade amnesia

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 To decrease the chances of aspiration
(Decrease acidity& Vol. of gastric content)
To control secretion-oral& resp

To prevent PONV

To control infection

To reduce the doses of anesthetic drugs.

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 Commonly use drugs

Benzodiazepam- Diazepam, Midazolam,

Alprazolam, lorazepam

Alfa 2 agonist- Clonidine, Dexmedetomidine

Opioids- Morphine, Pethidine, fentanyl

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 Anti emetics- Metochlopramide,
Domperidone, Ondensetron, Granisetron

Anti sialagouge/ Anti cholinergic- Atropine,

Glycopyrrolate

Anti biotic

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THANK YOU
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