pre anesthetic examination

1. Preanesthesia evaluation (PAC)
PRESENTED BY Dr. ATTINDER PAL SINGH
MENTOR - Dr. ARVIND ARYA SIR H.O.D.
DEPARTMENT OF NEUROANESTHESIA (IHBAS)

2. WHAT IS IT ?
• Its a process of clinical assessment that
precede the delivery of anesthesia care for
surgery and for non surgical procedure
(e.g.MECT).
• clinical foundation for guiding perioperative
patient management

3. OBJECTIVES
• discovery or identification of a disease or disorder that
may affect perioperative anesthetic care
• verification or assessment of an already known
disease, disorder, medical or alternative therapy that
may affect perioperative anesthetic care
• formulation of specific plans and alternatives for
perioperative anesthetic care.
• Inform and educate the patient about anaesthesia,
perioperative care and pain management
• Obtain informed consent for anaesthesia

4. Components
• Preanesthetic history
• General Physical examination
• Systemic examination
• Airway examination
• investigations

5. HISTORY TAKING
• demographic details
• presenting complaints
• previous medical history and comorbidities
• previous surgical and anesthetic exposure
• previous history of difficult airway, drug
allergies and postop icu stay
• personal history
• drug and family history

6. GENERAL PHYSICAL EXAMINATION
• look for pallor ,icterus, clubbing,cyanosis,pedal
edema and lymphadenopathy
• weight and height measurement
• Preoperative Hemodynamic parameters NIBP,
PR, RR & TEMP.

7. SYSTEMIC EXAMINATION
• respiratory system
• cardiovascular system
• cental nervous system
• GI examination
• special focus : airway examination, spine
examination & peripheral venous access

8. AIRWAY EXAMINATION
• mouth opening (interincisors distance more than 4.5cm roughly 3 fingers )
• dentition and tongue
• mallampati grading
• thyromental distance 6.5cm
• sternomental distance 12.5
• temparomandibular joint mobility
• cervical joint movements
• position of trachea

9. Mallampati Grading

10. RESPIRATORY EXAMINATION
• Inspection • Rate & Rhythm , chest expansion
,symmetry of chest expansion , movements of
the chest wall presence of intercostal recessions
or the use of accessory muscles
• Palpation Position of the Apex beat and Trachea
• Percussion
• Auscultation Breath sounds

11. CARDIOVASCULAR EXAMINATION
• INSPECTION: apex beat , chest shape, abnornmal
vessels ,any lumps,or previous scars
• PALPATION: confirm apex beat, all peripheral
pulses,presences of any thrills
• PERCUSSION: heart borders
• AUSCULTATION: S1 , S2 & murmurs.

12. American Society of Anesthesiologists
Classification

13. INVESTIGATIONS
Blood Tests
• Hemoglobin Hematocrit Complete blood count Coagulation studies
Serum chemistries (i.e., sodium, potassium, glucose) Potassium
Glucose Urinalysis (as distinct from pregnancy testing) Pregnancy
evaluation
Cardiac Evaluation
• Electrocardiogram
• Other cardiac evaluation (e.g., angiography, echocardiography,
stress tests) Cardiac function tests Echocardiography
(transesophageal, transthoracic) Stress tests Ventriculography
Pulmonary Evaluation
• Chest radiography
• Other pulmonary evaluation (e.g.,pulmonary function
tests,spirometry)

15. DRUGS TO BE DISCONTINUED
• Antihypertensives: continue except ACE
inhibitors and ARBs
• Oral hypogycemics :skip morning dose
• Thyroid :continue on the day of surgery
• Heparin : 6to8hrs
• Clopidogrel : 5days
• Anticonvulsants : continued

16. INFORMED CONSENT
• for protecting the legal rights of patients and
guiding the ethical practice of medicine
• We inform the patient / gaurdian about the
procedure,type of anesthesia to be given and
complications involved .