Pre-operative assessment

NB Many trusts will have a preassessment form which will guide you through the assessment and cover all the questions needed to be asked

  • WIPE 
    • wash hands, introduce self, check patient details and explain
      • NB When checking patient details, you should also check what operation they are to have (and what kind of anaesthesia) and when this is going to be
  • History
    • Ask about present health:
      • Presenting complaint and history
      • General systems history (CVS; Resp; GI; GU; Endo/Diabetes; Neuro)
      • Any recent or current illness
      • Current exercise tolerance
      • Any smoking? Any alcohol? Who is with them at home?
      • Any sleep apnoea?
    • Ask about PMHx and Rx
      • In particular any diabetes, epilepsy, any CVD, asthma/COPD, hypertension (and how well each is controlled)
      • What medication is the patient taking?
        • Some medications may require advice re: stopping before surgery (and when to restart)
        • Make sure to ask about aspirin, clopidogrel, rivaroxiban (and other NOACs), warfarin… in particular
      • Previous surgical history
    • Anaesthetic Hx
      • Previous general anaesthetics; reactions/complications
        • If the patient has not had any GAs, ask about family history of reactions/complications
      • Dental prosthesis
    • Social
      • Smoking and Drinking
      • Exercise tolerance
      • Support (independent/family/care etc)
    • Family Hx
    • Full systemic review (cardiorespiratory; gastrointestinal; neurological; musculoskeletal; urological/gynaecological etc)
  • Examination
    • Anaesthetic assessment
      • Examine neck movement and any limitation in ROM
      • Examine how wide the patient can open their jaw and grade this (Mallampati grading)
        1. See all of soft palate and uvula
        2. See half of uvula
        3. See a small gap at end of soft palate
        4. Only see hard palate
    • Multi-system assessment (Head to toe)
      • Examine Cardiorespiratory system fully; abdomen; calves +/- any systems involved in the surgery

NICE recommends various investigations based on the severity of the surgery (minor; intermediate; major and major +; as well as cardiovascular surgery and neurosurgery) as well as patient baseline function and comorbidities (ASA graded depending on severity of co-morbidity).

In general, an investigation is only required to confirm a diagnosis or exclude a differential; assess the appropriateness of the surgical intervention; assess fitness for surgery.  In short- will the investigation alter the surgical management of the patient.  Investigations may include (if they have not been requested a week prior to surgery)

  • CXR
  • ECG
  • Bloods (FBC; U&Es; clotting +/- others e.g. LFTs; glucose; amylase)
  • Urinalysis
  • Blood gases
  • Lung function tests

Other things to consider pre-operatively

  • VTE Prophylaxis
  • Drugs
    • In particular, diabetes drugs e.g. oral antihyperglycaemics (see also Diabetes and Surgery)
    • When to stop antiplatelets and anticoagulants
    • Antihypertensives (diuretics and ACEIs usually withheld on the day of surgery)
  • Fasting information
  • Consent

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