Preoperative preparations Obtaining consent The patient has ...

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Patient assessment for anesthesiaAnesthetists commonly measure the severity of the patient comorbidity, and assess the risk ofanesthesia according to the American Society Anesthesia (ASA) scale: ASA I Healthy patient. The pathological process requiring surgery is localized, e.g.a fit young patient with an inguinal hernia. ASA II Mid to moderate systemic disease which may/may not be related to thepathological process requiring surgery,e.g. patient on medication for hypertension. ASA III Severe systemic disease limiting activity, e.g. a patient with angina onwalking 200 yards. ASA IV Severe systemic disease posing a constant threat to life, e.g. a patient withangina at rest. ASA V A moribund patient unlikely to survive 24 hours with or without surgery, e.g.an elderly patient with septic shock from perforated diverticular disease.Routine preoperative testingTestCommentComplete blood cell count Possibility of substantial blood loss, patients withchronic illnesses or symptoms of anemiaUrinalysisUrologic symptoms, instrumentation of the urinarytract, possibility of surgical placement of prostheticmaterialsSerum electrolytes, Age >50, chronic diarrhea, renal disease, livercreatinine, and blood urea disease, diabetes, CHF or other cardiac disease,nitrogenhypertension (HTN), major procedure, diuretic use,digoxin use, ace inhibitor useCoagulation studiesBiochemical profiles(including liver enzymes)Pregnancy testingChest x-rayElectrocardiogramFamily history of bleeding disorder, patient history ofabnormal bleeding, anticoagulant usage, liver disease,malnutrition, chronic antibioticsHistory of liver or biliary disease. (Albumin strongpredictor of perioperative morbidity and mortality,should be considered for major procedures.)Any woman of childbearing age (exceptposthysterectomy patients)Acute cardiac or pulmonary symptomsMen >40, women >50, history of cardiovasculardisease or arrhythmia, diabetes, HTN6
Type and cross/type andscreenNone if very low risk of blood loss. Type and screen ifrisk of substantial blood loss is low to moderate; typeand cross if moderate to high risk of substantial bloodloss7
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