Preanesthetic assessment

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A review of the medical chart helps identify any risk factors that could impact anesthesia, including:

• Pacemakers or bleeding disorders: These conditions may influence anesthesia choices.{{Cite journal |last1=Shah |first1=Ushma Jitendra |last2=Narayanan |first2=Madan |last3=Graham Smith |first3=J |date=2015-02-01 |title=Anaesthetic considerations in patients with inherited disorders of coagulation |url=https://linkinghub.elsevier.com/retrieve/pii/S1743181617300173 |journal=Continuing Education in Anaesthesia Critical Care & Pain |volume=15 |issue=1 |pages=26–31 |doi=10.1093/bjaceaccp/mku007 |issn=1743-1816}}{{Cite web |title=UpToDate |url=https://www.uptodate.com/contents/perioperative-management-of-patients-with-a-pacemaker-or-implantable-cardioverter-defibrillator |access-date=2025-03-24 |website=www.uptodate.com}}
• Higher risk of nausea: Postoperative nausea and vomiting (PONV) is more common in female patients, particularly younger individuals.{{Cite journal |last1=Apfel |first1=C.C. |last2=Heidrich |first2=F.M. |last3=Jukar-Rao |first3=S |last4=Jalota |first4=L |last5=Hornuss |first5=C |last6=Whelan |first6=R.P. |last7=Zhang |first7=K |last8=Cakmakkaya |first8=O.S. |date=November 2012 |title=Evidence-based analysis of risk factors for postoperative nausea and vomiting |url=https://linkinghub.elsevier.com/retrieve/pii/S0007091217316367 |journal=British Journal of Anaesthesia |volume=109 |issue=5 |pages=742–753 |doi=10.1093/bja/aes276|pmid=23035051 }}
• Past anesthesia complications: Difficulty with intubation or excessive nausea after previous surgeries should be noted.

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A face-to-face discussion with the anesthesia provider helps ensure all necessary precautions are taken.

• Addressing Anxiety: Providing information about the procedure can help ease concerns.{{Cite journal |last1=Mohan |first1=Brij |last2=Kumar |first2=Rajan |last3=Attri |first3=Joginder Pal |last4=Chatrath |first4=Veena |last5=Bala |first5=Neeru |date=2017 |title=Anesthesiologist's Role in Relieving Patient's Anxiety |journal=Anesthesia: Essays and Researches |volume=11 |issue=2 |pages=449–452 |doi=10.4103/0259-1162.194576 |doi-access=free |issn=0259-1162 |pmc=5490100 |pmid=28663639}}
• Discussing Anesthesia Options: Determining whether general or regional anesthesia is most appropriate with the patient's preferences in mind.
• Jewelry or Piercings: Removal is often required to prevent complications. A metal piercing could cause a severe burn if electrocautery is used during surgery.
• Uncontrolled Medical Conditions: Uncontrolled blood sugar or blood pressure may need management before the surgical case.
• Religious Considerations: Some patients, such as Jehovah’s Witnesses, may decline blood transfusions, and this should be clarified with the anesthesia provider.{{cite book | vauthors = Samuels JD | chapter = The Patient Who Is A Jehovah’s Witness |date=1991 | veditors = Frost EA | title = Preanesthetic Assessment 3 |pages=87–100 | doi = 10.1007/978-1-4684-6790-1_7 |place=Boston, MA |publisher=Birkhäuser Boston |isbn=978-1-4684-6792-5 }} Those of the Muslim faith may have specific requests in terms of physical contact.{{Cite journal |last=McKennis |first=Ann T. |date=1999 |title=Caring for the Islamic Patient |url=https://aornjournal.onlinelibrary.wiley.com/doi/10.1016/S0001-2092%2806%2961885-1 |journal=AORN Journal |volume=69 |issue=6 |pages=1185–1196 |doi=10.1016/S0001-2092(06)61885-1 |pmid=10376090 |issn=1878-0369}}
• Eating or Drinking Before Surgery: Failure to follow NPO (nothing by mouth) guidelines may postpone surgery for safety reasons.{{Cite web |title=Why Do They Say Not To Eat Before Surgery? |url=https://health.clevelandclinic.org/why-cant-you-eat-before-surgery |access-date=2025-03-24 |website=Cleveland Clinic }} Anesthesia medications can temporarily impair the muscles responsible for keeping food and liquids in the stomach. Consuming food or liquids beyond the instructed time can significantly increase the risk of aspiration (stomach contents entering the lungs), which can lead to serious complications, including the need for intensive care. Normal muscle function returns once anesthesia has worn off, and the patient is transferred to the post-anesthesia recovery unit.
• Confirming the Surgical Plan: An extra safety measure to verify all necessary details.

Medications:

• Diabetes: Adjustments to insulin or other medications may be necessary.  Certain drugs, such as GLP-1 {{Cite web |title=American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists |url=https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative |access-date=2025-03-24 |website=www.asahq.org}} and SGLT2 inhibitors, may require special instructions.  These medications can prevent the stomach from emptying out normally, seriously increasing the risk of choking on stomach contents when a breathing tube is inserted and removed.
• Blood Thinners: Medications like aspirin or warfarin may need to be paused before surgery.{{Citation |last1=Polania Gutierrez |first1=Javier J. |title=Perioperative Anticoagulation Management |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK557590/ |access-date=2025-03-24 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491522 |last2=Rocuts |first2=Klifford R.}}
• Herbal Supplements: Some natural remedies can affect blood clotting or interact with anesthesia.
• Seizure Medications: Certain epilepsy drugs are sometimes held before surgery, depending on the procedure.

• File:Cmdr. William Cavill examines a child before her surgery. (20318997075).jpgAirway Evaluation: The anesthesia provider may use the Mallampati score or other tools to predict potential intubation difficulties.  This occurs when the anesthesia provider asks patients to open their mouths widely for inspection.  They may also ask the patient to turn their head side to side or to look up at the ceiling.
• Lung Health: Conditions such as asthma, sleep apnea, or smoking history can impact breathing under anesthesia. Frequently, a preoperative chest x-ray is performed to ensure readiness for possible ventilatory support during surgery.
• Heart Health: Surgery can be considered to be as stressful as walking up 1-2 flights of stairs. The inability to tolerate such exertion may require modifications to the anesthetic plan. Sometimes, a 12-lead EKG may be necessary to ensure a patient's heart is ready. In select cases a more in-depth test called a transthoracic echocardiogram (ultrasound of the heart) is also performed.
• Physical Limitations and Frailty: Issues with mobility, stiff joints, or other conditions may affect positioning during surgery. These challenges tend to be more common for the elderly who require up to four times the number of surgical procedures.{{Cite journal |last1=Buigues |first1=Cristina |last2=Juarros-Folgado |first2=Pilar |last3=Fernández-Garrido |first3=Julio |last4=Navarro-Martínez |first4=Rut |last5=Cauli |first5=Omar |date=11 January 2015 |title=Frailty syndrome and pre-operative risk evaluation: A systematic review |url=https://linkinghub.elsevier.com/retrieve/pii/S0167494315300340 |journal=Archives of Gerontology and Geriatrics |volume=61 |issue=3 |pages=309–321 |doi=10.1016/j.archger.2015.08.002|pmid=26272286 }}

File:Intravenous catheter.jpg

Before a patient is taken to the operating room, an anesthesia provider verifies the number and size of intravenous (IV) catheters required for the procedure. IV access is essential for administering fluids, medications, and life-saving blood products.{{Cite web |title=How to Establish Safe and Effective IVs - Ambulatory Anesthesia - Augu |url=https://www.aorn.org/outpatient-surgery/article/2008-August-how-to-establish-safe-and-effective-IVs |access-date=2025-03-26 |website=Outpatient Surgery Magazine |language=en}} In many cases, two IV catheters are placed as a precaution in case one fails during the procedure. Larger-bore IVs may be necessary to accommodate high-volume fluid administration. For patients with allergies to inhaled anesthetics, anesthesia can sometimes be administered exclusively through an IV.{{Cite journal |last=Miller |first=Timothy E. |last2=Gan |first2=Tong J. |date=June 2015 |title=Total Intravenous Anesthesia and Anesthetic Outcomes |url=https://linkinghub.elsevier.com/retrieve/pii/S1053077015000452 |journal=Journal of Cardiothoracic and Vascular Anesthesia |language=en |volume=29 |pages=S11–S15 |doi=10.1053/j.jvca.2015.01.022}} In cases where IV access is challenging due to patient-specific factors, ultrasound guidance may be used to facilitate catheter placement.{{Cite journal |last=Weiner |first=Menachem M. |last2=Geldard |first2=Paul |last3=Mittnacht |first3=Alexander J.C. |date=April 2013 |title=Ultrasound-Guided Vascular Access: A Comprehensive Review |url=https://linkinghub.elsevier.com/retrieve/pii/S1053077012003503 |journal=Journal of Cardiothoracic and Vascular Anesthesia |language=en |volume=27 |issue=2 |pages=345–360 |doi=10.1053/j.jvca.2012.07.007}}

There are many details to be covered before anesthesia is provided. The information covered and how depends on the needs of the patient.{{Cite journal |last1=Tait |first1=Alan R. |last2=Teig |first2=Magnus K. |last3=Voepel-Lewis |first3=Terri |date=September 2014 |title=Informed consent for anesthesia: a review of practice and strategies for optimizing the consent process |url=https://link.springer.com/10.1007/s12630-014-0188-8 |journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie |volume=61 |issue=9 |pages=832–842 |doi=10.1007/s12630-014-0188-8 |pmid=24898765 |issn=0832-610X}} If available, the anesthetist may offer different options for pain control during and after surgery. Adverse effects of anesthesia and need for possible admission to the intensive care unit (ICU) are discussed.{{Cite journal |last1=Tylee |first1=Michael J. |last2=Rubenfeld |first2=Gordon D. |last3=Wijeysundera |first3=Duminda |last4=Sklar |first4=Michael C. |last5=Hussain |first5=Sajid |last6=Adhikari |first6=Neill K. J. |date=2020-11-12 |title=Anesthesiologist to Patient Communication: A Systematic Review |journal=JAMA Network Open |volume=3 |issue=11 |pages=e2023503 |doi=10.1001/jamanetworkopen.2020.23503 |issn=2574-3805 |pmc=7662141 |pmid=33180130}} Patients have the opportunity to ask questions and make decisions to guide their care.

A mnemonic has been suggested for pre-anesthetic assessment, to ensure that all aspects are covered.{{cite journal | vauthors = Hemanth Kumar VR, Saraogi A, Parthasarathy S, Ravishankar M | title = A useful mnemonic for pre-anesthetic assessment | journal = Journal of Anaesthesiology Clinical Pharmacology | volume = 29 | issue = 4 | pages = 560–561 | date = October 2013 | pmid = 24250002 | pmc = 3819859 | doi = 10.4103/0970-9185.119127 | doi-access = free }} It runs alphabetically:

:A – Affirmative history; Airway

:B – Blood hemoglobin, blood loss estimation, and blood availability; Breathing

:C – Clinical examination; Co-morbidities

:D – Drugs being used by the patient; Details of previous anesthesia and surgeries

:E – Evaluate investigations; End point to take up the case for surgery

:F – Fluid status; Fasting

:G – Give physical status; Get consent

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Category:Surgery

Category:Medical mnemonics

Category:Anesthesia