Anesthesia Student Survival Guide.pdf - Index of

THe PreoPerATIve PATIenT evAluATIon ● 93
been on a given medication – particularly opioids as chronic use may lead to
higher opioid requirements during the surgery and postoperatively. Additionally,
long-term use of steroids can lead to adrenal insufficiency and may require
steroid supplementation during surgery.
A medication history should also encompass any over-the-counter or alternative
medicines (i.e., herbal medications). This is important because many
supplements have important side effects that may manifest during anesthesia
(e.g., ginko and garlic both potentiate anticoagulant medications, St. John’s
Wort can prolong anesthesia, and Ephedra may cause arrhythmias).
Patients often state allergies to medications, foods, and environmental
agents. It is important to note what medications cause what allergic reaction,
and the severity of that reaction. For example, does penicillin cause a mild rash
or an anaphylactic reaction? Also, it is important to differentiate allergic reactions
from mere side effects (e.g., nausea and vomiting induced by morphine is
a side effect and not a true allergy). Allergies to latex (some OR supplies contain
latex), iodine, and shellfish are essential to elicit as well.
Medical Records/Family History
Medical records often contain a substantial part of patient’s medical history
– which the patient may or may not be aware of. They may include information
that could change your anesthesia plan. For example, a history of a difficult
airway may lead to a decision to perform an awake fiberoptic intubation
to maximize the patient’s safety. A history of severe postoperative nausea and
vomiting or hemodynamic problems during previous surgery may also help
the anesthesia provider make adjustments to the planned anesthetic.
Reviewing and screening for anesthetic complications within the patient’s
family may also alert the anesthesiologist to potential problems (e.g., history
of pseudocholinesterase deficiency or malignant hyperthermia) and should
therefore be elicited.
Laboratory Data
Up to 3 billion dollars are spent annually in the United States on preoperative
laboratory and diagnostic studies. Therefore, these studies should be used
in conjunction with patient’s medical history and surgical procedure.
Unnecessary testing can result in OR delays or even cancellations due to false
positive results. Table 8.3 illustrates the diagnostic and laboratory tests that
correspond to specific medical conditions and procedures.