KUNJUNGAN PRE ANESTESI

Effective Preoperative
Evaluation

• history and physical examination

• a complete account of all medications taken by the patient in the
recent past
• all pertinent drug and contact allergies
• responses and reactions to previous anesthetics.
• any indicated diagnostic tests, laboratory
investigations, imaging procedures, or
consultations from other physicians.
By convention, physicians in many countries use the American
Society of Anesthesiologists’ (ASA) classification to definerelative
risk prior to conscious sedation and surgical anesthesia
 Elements of Pre Op History
Patients presenting for elective surgery require a focused
preoperative medical history emphasizing:

1. cardiac and pulmonary function

2. kidney disease, endocrine and metabolic diseases
3. musculoskeletal and anatomic issues relevant to airway
management and regional anesthesia
4. history of responses and reactions to previous
anesthetics/drugs.
5. family/personal history
6. Any coexisting illness
7. Exercise tolerance
Cardiovascular issues
The core goals of preoperative cardiac assessment
are to :
1. determine the status of the patient's cardiac
conditions
2. to provide an estimate of risk
3. to determine if further testing is warranted
4. and to determine if interventions are warranted
to reduce perioperative cardiac risk.

 In general, the indications for cardiovascular

investigations are the same in surgical
patients as in any other patient.
 Pulmonary issues

Cases where there is markedly increased risk of

pulmonary complications :

• ASA Class 3 and Class 4 patients as compared to

Class 1 patients.
• Cigarette smoking
• Longer surgeries (>4 h)
• Certain types of surgery (abdominal, thoracic, aortic
aneurysm, head and neck, and emergency surgery)
• General Anesthesia (compared with cases in
which GA was not used)
Efforts required for prevention of
pulmonary complications

• focus on cessation of cigarette smoking

prior to surgery and on lung expansion
techniques (eg, incentive spirometry) after
surgery in patients at risk.
• Patients with asthma, have a greater risk
for bronchospasm during airway
manipulation.
• Appropriate use of analgesia and
monitoring are key strategies for avoiding
postoperative respiratory depression in
patients with obstructive sleep apnea.
Coagulation issues
Three important coagulation issues that must be addressed
during the preoperative evaluation:
1. How to manage patients who are taking warfarin on a long-
term basis
2. how to manage patients who are taking clopidogrel and
related agents
3. how to safely provide regional anesthesia to patients who
either are receiving longterm anticoagulation therapy or
who will receive anticoagulation perioperatively.
 patients deemed at high risk for thrombosis
(eg, those with certain mechanical heart valve
implants or with atrial fibrillation and a prior
thromboembolic stroke), warfarin should be
replaced by intravenous heparin or, more
commonly, by intramuscular heparinoids to
minimize the risk.
Gastro intestinal issues

the risk of aspiration is increased in

certain groups of patients:
o pregnant women in the second and third
trimesters,
o those whose stomachs have not emptied after
a recent meal,
o and those with serious gastroesophageal
reflux disease (GERD).
Treatment of GERD :
 to treat patients with consistent symptoms
(multiple times per week) with medications
(eg, nonparticulate antacids such as sodium
citrate) and techniques (eg, tracheal
intubation rather than laryngeal mask airway)
as if they were at increased risk for aspiration.
 Element of Preoperative
Physical Examination
1. measurement of vital signs (blood pressure,
heart rate, respiratory rate, and temperature)
2. examination of the airway, heart, lungs,
and musculoskeletal system
3. standard techniques of inspection,
auscultation, palpitation are used.
4. Breath holding time should be assessed in
every patient(normal value >25 seconds ; 15-
20seconds is considered borderline).
5. Proper examination of patient’s airway
6. Inspection of loose or chipped teeth,
caps, bridges, or dentures.
7. Micrognathia (a short distance between
the chin and the hyoid bone), prominent
upper incisors, a large tongue, limited
range of motion of the temporo
mandibular joint or cervical spine, or a
short or thick neck
Preoperative Laboratory Testing
1. Chest X-ray : done as a routine practice
2. Blood glucose measurement for diabetic
patient
3. Urine analysis
4. Coagulation profile for patients with suspected
coagulopathy (Hb,Ht concentration)
 Premedication
1. Mid-azolam  Adults often receive intrave-
nous midazolam (2–5 mg) once an intravenous
line has been established.
2. If a painful procedure (eg, regional block or a
central venous line) performed while the
patient remains awake, small doses of opioid
(typically fentanyl)
3. Patients who will undergo airway surgery 
anticholinergic agent (glycopyrrolate or
atropine) to reduce airway secretions
DOCUMENTATION
Preoperative
Assessment
Note
Intraoperative
Anesthesia
Record
Postoperative Notes
 Conclusion
Preoperative evaluation is scenario which utilizes vast
scales anaesthesiologists knowledge in a limited span to
ensure

• Increased quality of preoperative care

• Reduced mortality and morbidity of surgery
• Reduced cost of preoperative care
• Reduced anxiety
Terimakasih