Pre-op or pre operative assessment is a vital and lifesaving part of most of the surgical procedures and mainly in major surgeries which will require the patient to be put on general anaesthesia or in instances where the surgery will carry the risk of heavy blood loss. The idea of doing such an assessment is to detect any risk factors that has the potential to develop into post op complications as well as intra operative complications.
The pre-op assessment would most probably be performed by the anaesthetist involved with the surgery. This will involve several steps under the categories of history, examination and investigations.
Taking a detail history would enable the clinician to obtain much vital information from the patient. These would include the following.
Previous medical conditions such as diabetes, hypertension, heart disease as well as asthma Allergies to drugs or foods Transfusion reactions in the past Drugs that are being taken at this particular time Current medical problems such as cough, difficulty in breathing, chest pain, urine retention…etc. Any surgical complications associated with previous surgeries
Apart from the above, the clinician will also like to know social status, working requirements, social habits as well as family support as these would be vital in the recovery process of the patient.
Examining the patient can reveal many other important facts that will be useful in the management of a patient and in avoiding complications. These would include,
Pallor which indicate the presence of anemia Jaundice which will indicate to liver disease Irregular pulse which points to arrhythmia in the heart Feet swelling that could be due to renal disease, pressure effects as well as heart failure. Presence of tenderness and masses which will be useful in the intra op as well as post op management. Presence of fever Presence of shortness of breath Crepitating sounds in the lungs which can indicate lung disease or even heart failure. Rochi or whistling noises in the lungs indicating the presence of asthma Murmurs in the heart which indicates the necessity to exclude heart defects Abnormal blood pressures which prompts the clinician to obtain control and initiate treatment. Deformities in the spine which would contraindicate spinal anesthesia
What were mentioned in the above list are some of the important findings and by no means a complete list of possible examination findings.
In situations where a possible abnormality is detected or even suspected, the clinician would want to do investigations to further clarify these abnormalities. In certain situations, these investigations would be done routinely and will decide the possibility to undertake the surgery on the patient. Some of the common investigations that would be carried out as pre op assessment would be,
Haemoglobin levels : This will indicate the presence of anemia and will allow correction prior to the surgical procedure. Fasting blood sugar : This will be helpful in assessing the need to control the blood sugar levels as it will facilitate good wound healing and if not controlled could lead to infections. ECG : Specially in the elderly individuals, the test will perform to assess the heart function. Chest X-ray : This will eliminate the probable lung pathologies and will clear the way for a general anesthesia to be used. Clotting profile : These are sometimes vital in order to assess clotting problems specially in individuals who takes anti-clotting agents as well as in certain disease states. Renal assessment (Blood urea, serum creatinine, serum electrolytes) : These will enable the clinician to assess the function of the kidney as maintain adequate fluid intake during as well as after the surgery with close observation of renal parameters.
Apart from the above tests, there would be many other investigations that will be carried out depending on the surgery as well as the patients condition and would be decided by the anaesthetist or the surgeon as part of pre-op preparation.