PREOP EVALUATION

GOAL: Reduce morbidity of surgery. Increase quantity but decrease cost of preop care. Return patient to desirable functioning as quickly as possible.

PREOP EVALUATION
PURPOSE OF MEETING BETWEEN PATIENT & ANAESTHETIST: Obtain pertinent information about patients medical history, physical conditions, thus determine which tests & consultations needed. Obtain informed consent.

 Educate patient about anaesthesia preop care & pain treatments to allay anxiety & facilitate recovery. Guided by patient choice & risk factors care plans to be followed. Make preop care more efficient & less expensive.

PREOP EVALUATION
SUMMARY: Optimize patient health before surgery. Plan most appropriate perioperative management. Reduce rate of cancellation. Increase patient satisfaction.

PREOP EVALUATION
Preop evaluation gives practitioners confidence that they will not be surprised by unexpected patient conditions & gives patients confidence that health care system is responding to their individual conditions.

PREOP EVALUATION
A study at the University of Florida in Gainesville formed that preop evaluation provides information leading to changes in care plans for more than 15% of all healthy patient & 20% of all patient in general. Example of conditioner care: - Gastric reflux. - IDDM & NIDDM - Asthma - Suspected different int.

PREOP EVALUATION
HISTORY: In the beginning preop assessment relied only on accurate history taking & physical examination. In 1960s multiphase screening lab tests were added to the procedure

PREOP EVALUATION:CHANGING NATURE !!!

Is patient in optimal health Can or should the patient physical or mental condition be improved before surgery.

PREOP EVALUATION
Does patient have any health problem or use any medication that could unexpectedly influence perioperative events. Job of anaesthesiologist is not simply to put patient to sleep & wake him earlier after surgery, but to maintain. Pain therapy.

Haemostatis

PREOP EVALUATION
Anaesthesiologist must interfere with stress response induced by pain & manage the patients medical problems.

HISTORY
FIRST AREA OF CONCERN Last anaesthesia. Any problem (Also in family members) Allergies. Blood tests in last 6 months CXR in last 2 months. ECG in last 2 months Medications. Artificial aids (hearing, eyes, denture etc)

CVS: Congestive heart failure (CHF) highest risk Cardiomyopathy IHD Valvular HD HTN Cardiac rhythm Carditis Arteritis.

RESP & AIRWAY PROBLEMS: Evidence of airway obstructions Restricted jaw movements. Smoking. Occupational hazard. Chr bronchitis Emphysema Chr infection

HEPATIC OR GI DISORDERS: Hiatus hernia Hepatitis, Liver ds, Malaria etc. Gall bladder ds Bloody or tarry stools. ? Frequent, nausea with vomiting Rx history
BLEEDING PROBLEMS: Bleeding Tendency. Anemia. BT history

RENAL DS: Kidney problem. RF problem. Dialysis. Infections. Calculi.

(Voluntary avoidance of food having a high

proteins content is s/o Renal Disease)

ENDOCRINE DISTURBANCES: End organ effects of DM, Thyroid, parathyroid, pituitary, adrenal & carcinoid disease

QUESTIONS: - Frequency of micturition -diurnal variations

NEUROLOGICAL DS: -

QUES seizure stroke migraine tremors nv injury numbness,tingling antidepressants sedatives .

Arthritis LBA

MUSCULOSKELETAL DS: -

SENSITIVE AREA OF CONCERY: -

Pregnancy.
Illicit drug use.

AIDS etc

PHYSICAL EXAMINATION: G/E S/E

THANK YOU