Preoperative Assessment

Abstract

The preoperative evaluation of patients is an essential component of their subsequent successful management. Its importance is often underestimated and it can be time consuming. In addition to assessing the patient's physical health, the preoperative visit is the first contact between patient and anaesthetist so it is important for establishing the patient's confidence. The aims of assessment are summarized in Figure 1. The main objective is to avoid any unanticipated problems during the patient's subsequent management. Anticipation of potential difficulties allows a suitable plan to be made and avoids crisis management. In patients with challenging problems it is essential to involve senior anaesthetists and surgeons at an early stage and, if possible, to work at elective times. Specific demands imposed by the surgery must be considered, such as the expected blood loss or the risk of nausea and vomiting. The various anaesthetic and analgesic techniques can be discussed and the preoperative medication rationalized. Postoperative treatment in high dependency or intensive care units can be planned and elective cases deferred until such beds are available. In emergency surgery, the time for evaluation is limited, as is the opportunity to optimize the patient's medical condition or organize special investigations.