Pre-anaesthetic assessment for

general anaesthesia
If a patient has complex medical problems, a preoperative anaesthetic
assessment may be required as a separate consultation prior to the day of
surgery. The anaesthetist will particularly want to be aware of:

Behavioural issues, e.g. autism, developmental delay, extreme anxiety and needlephobia.
Syndromes, e.g. Down syndrome, velocardiofacial syndrome.
Cardiac disease, heart murmurs, previous surgery for congenital defects.
Respiratory disease, e.g. Asthma.
Airway problems, e.g. history of croup, cleft palate, micrognathia, previous tracheostomy,known history of
intubation difficulties, sleep apnoea.
Neurological disease, e.g. epilepsy, previous brain injuries, cerebral palsy.
Endocrine and metabolic disorders, e.g. diabetes, genetic metabolic disorders.
Gastrointestinal problems, e.g. reflux, difficulty swallowing or feeding.
Haematological, e.g. haemophilia, thrombocytopenia, haemoglobinopathies.
Neuromuscular disorders, e.g. muscular dystrophy.
Allergic Reactions
Latex allergy accounts for 19% of allergic
reaction in children and the most common
cause of intra-operative anaphylaxis
Medications
Most medications should be continued untilthe
time of anaesthesia unless there is a clear reason
to withhold (e.g. with anticoagulants or insulin).
Consultation with the primary physician should
be made before warfarin or aspirin is ceased to
make an assessment of the risk or benefit of
ceasing these drugs.
Management of diabetic patients will require
consultation with the patients endocrinologist.

Upper respiratory tract infection
It may be appropriate to delay elective anaesthesia for
23 weeks until the infection is treated.
The efficacy of GA will be lower in Patient with urti
However ,this decision can be balanced against
economic and social issues and patient factors such as
the childs age, urgency of treatment, severity of the
infection and any other medical problems the child
may have. Ultimately, the decision to cancel or proceed
is up to the anaesthetist.

Types of Adminstration of GA
Nitrous oxide
inhalation
Oral
induction
Rectal
induction
Intramuscular
induction
Intravenous
induction
Larry D. Trapp Techniques for Induction of General
Anesthesia in the Pediatric Dental Patient
Anesth Prog 39:138-141 1992