Preoperative Assessment Flashcards
Goal of the Preop Assessment
Make a safe anesthesia plan that minimizes risk and maximizes the quality of recovery
Pre-anesthesia History
Planned procedure/surgery, presenting illness, comorbid conditions, review of systems, past anesthetic history and any complications, allergies, medications , substance abuse, last oral intake. Severity of disease, efficacy of treatment for dz, and function.
ASA I
Normal, healthy patient.
Nonsmoking
Minimal to no alcohol use
ASA II
Mild systemic disease.
Mild dz w/o substantive functional limitations.
Ex: current smoker, social drinker, pregnant, obese, BMI between 30-40, well controlled DM and HTN, mild lung disease
ASA III
Patient with sever systemic disease. Functional limitations One or more moderate to severe diseases. Ex: DM, COPD, HTN, morbidly obese, alcohol abuse hx of MI, CVA, TIA, CAD > 3 months
ASA IV
Severe systemic disease that is a constant threat to life.
Recent MI, CVA, CAD w/ stent < 3 months
Valve dysfunction, alt EF DIC, sepsis
Acute severe illness
ASA V
Moribund patient that will not survive without surgery
Trauma, blown aneurysm, intracranial hemorrhage, ischemic bowel, cardiac problems
Or multisystem organ failure/dysfunction
MET number for low risk preoperative complications
Can tolerate 4 MET or more
Ex raking the leaves, gardening
or more
strenuous exercise.
Difficult Mask Ventilation
> 55 yo, OSA, Previous HEENT surgery, trauma or radiation, Lack of teeth, a beard, BMI >26
Difficult direct larynscopy
Asp PNA, hx Dif intubation, dental/oral trauma post intubation, OSA, snoring, Previous HEENT issues, congenital diseases (Downs, treacher collins, Pierre robin), Inflammatory disorders, scleroderma, ankylosing spondylitis, obesity, cervical spine disease/surgery
Mallampati Classification I
Visualize soft palate, fauces, ulvua, both anterior and posterior tonsillar pillars
Mallampati Class II
Soft palate, fauces, and ulvua
Mallampati Class III
Only soft palate and top of uvula
