Preoperative Assessment Overview

Preoperative Assessment

• Critical for elective surgery to identify and reduce risks, optimize medical condition, and ensure best health before surgery.
• Multidisciplinary approach involving surgeons, anesthesiologists, and primary care physicians.

Assessment Components

• Medication Use: Document all prescription, over-the-counter medications, and supplements.
• Allergies: Determine allergies, especially to medications (antibiotics, anesthesia drugs).
• Social History: Assess smoking, alcohol, and substance abuse as they affect anesthesia and recovery.
• Family History: Inquire about inherited disorders or anesthesia complications (e.g., malignant hyperthermia).
• Physical Examination:
  • Cardiovascular: Check for heart failure, arrhythmias (dyspnea, orthopnea, palpitation).
  • Respiratory: Evaluate lung function, especially in patients with smoking history or lung disease.
  • Airway Assessment: Evaluate potential intubation difficulties (Mallampati score).
  • Other Systems: Evaluate neurological, gastrointestinal, and renal issues.

Risk Stratification

• Cardiovascular Risk: Patients with heart conditions are at higher risk of perioperative complications. Tools like the Revised Cardiac Risk Index (RCRI) assess risk (history of ischemic heart disease, CHF, stroke, diabetes, renal insufficiency).
• Respiratory Risk: Pre-existing lung diseases (COPD, asthma) increase postoperative complication risk (Spirometry, chest X-rays are needed in high-risk patients).
• Metabolic Risk: Poorly controlled blood sugar (diabetes) increases infection and wound healing risk (HbA1c levels checked preoperatively).
• Bleeding and Clotting: Assess bleeding risk, especially in patients on anticoagulants. Management may involve stopping or adjusting doses perioperatively.

Laboratory Tests and Imaging

• Blood Tests: Full blood count, electrolytes, kidney function, liver function, and coagulation profiles.
• ECG: For patients with cardiovascular disease or over 40 years old.
• Imaging: Chest X-ray or other imaging based on medical history or physical findings.

Preoperative Optimization

• Aims to improve patient's condition before surgery.
• Cardiovascular Optimization:
  • Beta-blockers for high cardiovascular risk patients to manage blood pressure and heart rate.
  • Statins to reduce cholesterol and cardiovascular risk.
  • Smoking cessation (4-6 weeks before surgery) to reduce respiratory and cardiovascular risks.
• Respiratory Optimization:
  • Pulmonary rehabilitation and bronchodilators for lung disease to improve lung function.
  • Smoking cessation to reduce postoperative risks.
  • Preoperative breathing exercises (incentive spirometry, deep breathing) to enhance lung capacity.
• Glycemic Control (Diabetes):
  • Insulin adjustment to maintain optimal blood glucose during surgery (possibly shifting to regular insulin from racemic).
  • Metformin stopped 48 hours before surgery to reduce lactic acidosis risk.
• Anticoagulation Management:
  • Patients on anticoagulants (warfarin, DOACs, aspirin) may need bridging therapy with low-molecular-weight heparin (LMWH) to reduce bleeding or clotting risk during and after surgery.
• Nutritional Optimization:
  • Malnutrition: Protein supplementation or specialized nutrition plans to improve recovery and reduce infection.
  • Obesity: Weight management strategies reduce complications.
• Anemia Correction:
  • Iron supplementation or blood transfusions for patients with significant anemia to boost red blood cell levels.

Multidisciplinary Approach

• Crucial for effective preoperative assessment and care. Collaboration between surgeons, anesthesiologists, primary care physicians, and specialists is essential.