Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesAll patients with body mass index (BMI) of more than 40 (or BMI > 35with obesity related co-morbidities) should be seen by ananaesthetist in the pre-anaesthetic assessment clinic (PAAC) fourweeks before surgery.HistoryParticular attention should be given to co-morbidities:• Cardiovascular: IHD, hypertension, symptoms of heart failure.• Respiratory: asthma, COPD, obstructive sleep apnoea (OSA).• Diabetes.• Hiatus hernia or gastric reflux.• Immobility.ExaminationAll patients should have their height and weight measured, BMIcalculated and recorded in PAAC.Besides routine systemic examination attention should be given tothe following:• Venous access.• Airway assessment.• Examination of back for regional block if possible.• Prepare patient for both GA/RA.• Previous anaesthetic chart should be checked for airwaymanagement problem or any other critical incidents.InvestigationsAccording to NICE guidelines as for routine surgery.• Check random blood sugar. If it is >5.5 mmol L -1 then checkfasting blood sugar.214 Anaesthetists Handbook January 2010