Preoperative Assessment
In the preoperative management of the patient, the anesthesia provider will assess the major medical conditions that might affect the anesthetic plan. These generally revolve around the major organ systems, such as the heart, lungs, kidneys and brain; however, close attention is also paid to the head and neck anatomy and mobility (airway), IV access and positioning of the patient. The anesthesia provider is constantly assessing the worst case scenario and trying to mitigate these risks by planning. Therefore, they usually try to be very prepared for most possible adverse outcomes. The knowlege gained in the preoperative assessment is critical to help determine the best action plan for the specific patient and procedure.
Anesthesia providers are keenly concerned to maintain a patent airway. A thorough pre-operative anesthesia plan is often the best prevention of peri-operative complications. Anesthesia providers need to make sure that the airway management will not be compromised by patient positioning.
After meeting you, your anesthesiologist will assign an American Society of Anesthesiolgists (ASA) classification number. This simple metric provides the anesthesiologist with an ability to risk stratify the patient.
| ASA PS | Definition |
| 1 | Healthy |
| 2 | Mild systemic disease |
| 3 | Severe systemic disease |
| 4 | Severe systemic disease that is a constant threat to live |
| 5 | Moribund patient not expected to survive without surgery |
| 6 | Declared brain-dead organ donor |
Preoperative testing requirements will depend on the specific comorbidities of the patient and are beyond the scope of this website, but please consult with your anesthesiologists at your earliest convinience regarding any questions about a patient who might have a complicated medical condition (recent MI, recent surgery, currently anticoagulated, lack of capacity to consent, etc). This "heads-up" is of vital importance to provide our patients with the safest anesthetic for their procedure.
Finally, an important concept to the anesthesia providers is a matter of procedure time and sedation depth required. The selection of anesthetic drugs can be tailored for a short time or for deep sedation. The procedure type, length and stimulation will also affect the choice of sedation or general anesthesia and the method of airway management. It is important to communicate whether the complexity of the procedure for the specific patient as that will affect the anesthetic management.
Simple questions that may be asked by the anesthesia providers include recent lab results, such as the current creatinine level (to assess renal function), the last potassium (for use of succinylcholine), the current hemoglobin (to assess the need for transfusion), the left ventricular ejection fraction (to assess heart function), or may ask you "quality of life" questions such as the ability to climb up a flight of steps / walk a city block / or your perform activities of daily living. (to assess overall functional status), presence of obstructive sleep apnea (to assess for risk of sedation and possibly pulmonary hypertension), current IV access (for practical reasons and resuscitation).
