Manual of Clinical Anesthesiology: Pre-Op Assessment

Question 1

What labs should be ordered as part of pre-op assessment?

Answer 1

None, if the patient is asymptomatic

• If they are on diuretics, get a BMP.
• If they have kidney or liver disease, get a CMP.
• Any disease that affects the blood, get a CBC.
• Coagulation studies for disorders that affect the clotting cascade.
• b-HCG for any woman who might be pregnant.

Question 2

Discuss what to review in the patient’s history.

Answer 2

• PMH (specifically, respiratory, cardio, neuro, GERD, and neck problems)
• PSH
• ROS
• Anesthesia history (any problems with sedation, PONV, or MH)
• Surgical history (bleeding?)
• Loose teeth

Question 3

Thyromental distance less than ___________ is indicative of poor probability of intubation.

Answer 3

6 cm

Question 4

Describe METs and how they fit into the pre-op assessment.

Answer 4

• < 3 METs: walking slowly
• 3 - 6 METs: walking briskly
• > 6 METs: jogging

Being able to do greater than 4 METs without symptoms suggests that the person’s heart is safe for surgery.

Question 5

Go through the ASA system.

Answer 5

• 1: no illness
• 2: mild systemic illness
• 3: severe systemic illness
• 4: systemic illness that could be lethal at any time
• 5: dying patient
• 6: dead patient undergoing organ donation