3. Airway assessment
Other examination
Investigations
Pre op drug therapy and
modification
Premedication
Fasting guidelines
References
4. Basic element of anaesthesia care
PERIOPERATIVE MEDICAL
SPECIALISTS
Assessment and optimisation of
patients who are being prepared
for surgery
5. Joint commission mandates
documentation of history and
physical examination for any
surgical patients WITHIN 30 DAYS
before the planned procedure
Reassessment WITHIN 48 HRS
preceding surgery
6. Personal interview in the ward,
operating theatre or PAE clinic or
Preset questionnaires assisted by
trained nursing or paramedical
staff under the supervision of an
anaesthesiologist
8. More selective ordering of lab
tests.
Reduced patient anxiety.
Improved acceptance of regional
anaesthesia.
9. Shorter duration of
hospitalisation.
Lower hospital costs.
Fewer case cancellations on the
day of surgery
10. Every patient should be
considered as COVID 19 positive
and anaesthetists should wear
MASK(N 95) all the time
WASH hands –soap and
water/alcohol based sanitizer
frequently
11. Wear cap,gown &shoe cover, GLOVES
FACE SHIELD/GOGGLES
Maintain SOCIAL DISTANCING
Restrict NUMBER of attendants to PAC
Prevent CROWDING in PAC
12. History of FEVER,COUGH,SORE
THROAT
Record body TEMPERATURE before
entering PAC clinic
13. Patients should also wear MASKS
Detailed PAC to be taken-TRAVEL
international/domestic to affected
areas in last 14 days
Careful chest auscultation
14. All reusable equipments (steth,BP
apparatus)SANITISED frequently
At the end of day , clean by
wiping surfaces of furniture and
floor with 2-3% hydrogen
peroxide
Correct method of using and
disposing surgical masks
15. Introduction of the medical
practitioner performing the
consultation.
Confirmation of the patient’s
identity , procedure including site
and side
16. Medical assessment of the patient
- History
−Review patient records
− Clinical examination ( Systemic
and Airway)
− Medications
− Relevant investigations
- Previous anaesthesia records
18. Information regarding pain
management
Information regarding
modification of current
medications
19. Requirement of assistance after
the procedure
Educate patient regarding
modifiable health factors
20. Rapport with patient and family-
reduce anxiety
Clear and detailed documentation
21. Name, Age, Sex
Date & time of examination
Source of history: patient, relative,
care taker.
Occupation and social status
22. Community / Religion
Atypical pseudocholinesterase
in Shetty community
HPI- indication for surgery and
planned procedure
Mode of onset, cause of onset,
progress and treatment received
23. History of recent respiratory
infections
Menstrual history
History of allergy
24. History pertaining to various
symptoms
a. Cardiovascular system
b. Respiratory system
c. Central Nervous system
d. Gastrointestinal tract
e. Genito-Urinary system
f. Musculoskeletal
g. Hematological system
h. Endocrine system
25. History of medications- especially
OTC
History of addictions
History of previous surgery
History of previous anesthesia
26. Any treatment for cancer
Family history of any adverse
events related to anesthesia
History of snoring
27. Antenatal history
Term/pre term
Birth weight
Mode of delivery- indication
History of ICU admission
29. CVS complications are common
perioperative adverse events
50% of peri-op deaths
30. Identify risk factors
Severity of the disease
Need for pre-op interventions
Risk of peri-op adverse events
31.
32. Evaluated by the estimated energy
requirement for various activities
Graded in metabolic equivalents
(METS) on a scale defined by the
Duke Activity Status Index
One MET represents the oxygen
consumption of a resting adult
(3.5 ml/kg/min)
33.
34.
35.
36. Risk factors for post-op
pulmonary complications
Procedure-related risk factors: −
how close the surgery is to the
diaphragm (i.e. upper abdominal
and thoracic surgery are the
highest risk procedures).
37. Length of surgery (> 3 hours)
and general anesthesia
Emergency surgery.
Underlying chronic pulmonary
disease or symptoms of
respiratory infection
Smoking.
38. Age >60 years.
Obesity.
Presence of obstructive sleep
apnea. (STOP BANG questionnaire)
Poor exercise tolerance or poor
general health status
39.
40. Documentation regarding
previous airway difficulty?
Impact of surgery on the airway?
Difficult BMV
Difficult SADs
Difficult intubation
41. Difficult infra glottic airway
Aspiration risk
Altered cardio-respiratory
physiology?
Ease of extubation
42. Previous history of any previous
anaesthesia issues including
difficult intubation
GER
OSA
BMI
43. Mouth opening and interincisor
gap (IIG)
Modified Mallampati score
Teeth examination
44. Upper lip bite test
(ULBT)/Mandible protrusion test
Thyromental distance (TMD)
Cervical spine movement
45. Pierre Robins - Micrognathia,
macroglossia, cleft soft palate
Treacher – Collins - Auricular and
ocular defects, malar and
mandibular hypoplasia
46. Goldenhaar - Auricular and ocular
defects, malar and mandibular
hypoplasia
Downs - Poorly developed or
absent bridge of the nose,
macroglossia
47. Klippel Fiel - Congenital fusion of
a variable number of cervical
vertebrae, restriction of neck
movement
Acquired : − Infections : Abscess,
Croup Arthritis , Benign tumors ,
Acromegaly ,Burns
48.
49. It is the distance between the
upper and lower incisors.
Normal is 4.5 cm or more;
< 3.5 cm predicts difficult airway
50.
51. Distance from the mentum to the
thyroid notch while the patient’s
neck is fully extended.
TMD< 3 finger breadths or < 6
cm in adults
52.
53. Distance from the suprasternal
notch to the mentum with the
head fully extended on the neck
with the mouth closed.
Less than 12 cm
54.
55. Measurement of mandibular
length from chin (mental) to hyoid
At least 4 cm or 3 finger breadths
56.
57.
58. Flexion of neck
Atlanto occipital (AO) joint
extension
Normally more than 35 degrees
Turn right and left
Rotate head
59. L - Look externally (facial trauma,
large incisors, beard or
moustache, large tongue)
E - Evaluate the 3-3-2 rule
(IIG>3fb, HMD > 3FB and
TMD>2fb)
60. M - Mallampati (Mallampati score
> 3).
O - Obstruction (presence of any
condition like epiglottitis,
peritonsillar abscess, trauma).
N - Neck mobility (limited neck
mobility)
64. System examination
IV access
Positioning of patient
Teeth
Spine
Assess the pain score
65.
66. Complete blood count
Major surgery
Chronic CVS,renal,pulmonary or
hepatic d/s or malignancy
Known or suspected
anemia,bleeding
diathesis,myelosuppression
Less than one year of age
67. Hb less than 8g%-transfuse and
repeat Hb on day of sx
Serology
INR, aPTT
Anticoagulant therapy
Bleeding diathesis
Liver disease
74. Administration of most drugs
should be continued up to and
including the morning of
operation
75. Stop 6 weeks before – OCP
Stop 2-3 weeks before – MAO
inhibitors, Herbal supplements
Stop 1 week before – Clopidogrel
76. Stop 4 -5 days before – Oral
anticoagulants
Stop 24 – 48hrs before – NSAIDS
Stop on day of surgery –
− OHA /Insulin
− ACEI & ARBs
− Diuretics-unless severe heart
failure
81. Alleviate anxiety / sedation/
amnesia : Benzodiazepines(NOT
in pediatric,pregnant,geriatric and
very sever copd)
Patient already on antianxiety
drugs needn’t give
83. Fasting prior to procedure is to
decrease the risk of peri-
operative regurgitation, which
may result in aspiration
syndrome.
Before any anesthetic procedure.
84. Prescribed medications may be
taken with a sips of water less
than two hours prior to
anaesthesia unless otherwise
directed
85. Ask to start IVF @ 50-75ml per
hour from 6am
For cases posted noon or later
Caution in CKD,low EF patients
86.
87. Informed consent
Blood arrangement( open
abdominal
Sx,hysterectomy,LSCS,hip dx,
neuro sx,major head and neck
sx,any major sx,anemic patient)
88. A – Allergies
M – Medical history
P – Previous surgery
L – Last meal
E – Events leading up to the
surgery
89. A minimum pre anesthetic
physical examination should
include
1. Airway examination
2. Pulmonary examination to
include auscultation of the lungs
3. Cardiovascular examination
90. Miller’s anesthesia 9th edition
IJA,year 2020,volume-64,pages
267-274
ASRA and pain medicine April
2018 guidelines
