Preoperative Evaluation - What, How, Why, and More?

preoperative evaluation: A time-saving algorithm By - Michael J. Arnold

What is a preoperative evaluation?

Preoperative evaluation means the clinical investigation that precedes anesthesia before any surgical intervention. It includes history and physical examination with an emphasis on risk factors for heart, lung, and infectious complications, and an assessment of the patient's functional performance is essential for preoperative evaluation. Careful medical history and physical examination are the most important factors in preoperative lung risk assessment.

The motive of preoperative assessment is not to "release" patients for elective surgery, but to evaluate and take action to prepare high-risk patients for surgery. Preoperative outpatient care evaluation can reduce hospital stays and minimize postponement or cancellation of surgery.

How will you be proceeding with preoperative evaluation?

•Patient ID: The nurse will ask for your name and date of birth, check your ID and compare it to your record.

•Medical history and physical examination: Medical history must include past and present medical history, surgical history, and family history.

• Sample of blood

• X-ray of chest and other indicated scans

• Consultation for anesthesia

• Nurse consultation

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Why is a preoperative evaluation done?

The ultimate goal of preoperative medical evaluation is for the patient.

It is to shorten the operation period and the anesthesia period, morbidity or mortality, and return to the desired function as soon as possible.

Careful preoperative evaluation is essential for good surgical results. Also, helps to decide the benefits of surgery vs no surgery vs no treatment. Decisions about a patient's surgical ability are usually made weeks before surgery. But the evaluation is modified in case of emergency surgery when the decision is to be taken in a short period of time.

The main purposes of preoperative evaluation are as follows.

● Documentation of conditions requiring surgery.

● Assessment of the patient's general health.

● Reveal hidden conditions that can cause problems both during and after surgery.

● Determines the perioperative risk.

● It optimizes the patient's condition and reduces the patient's peri-operative morbidity or mortality from surgery and anesthesia.

● Creating a relevant per-operative care plan.

● Educate patients on surgery, anesthesia, intra-operative care, and

postoperative pain management in the hope of reducing anxiety and promoting recovery.

● Reduce costs, reduce hospitalizations, reduce cancellations, and improve patient satisfaction.

How is a preoperative evaluation done?

Preoperative preparations for patients include:

Medical records and bodily examination

These are carried out and documented via a health practitioner or a registered nurse. Allergies must be noted. The preoperative nurse establishes the baseline for the affected person`s critical signs.

Lab Tests

Testing must be primarily based totally on precise scientific signs or hazard elements that would have an effect on surgical control or anesthesia. Tests are done according to age, sex, preexisting sickness, the significance of the surgical procedure, and kind of anesthesia.

• Hemoglobin, hematocrit, blood urea nitrogen (BUN), and blood glucose can be mechanically examined for patients who are 60 years or older.

• Hematocrit is generally ordered for girls of every age.

• A complete blood count and blood biochemistry profile are done for every patient. Differential counts, platelets count, activated partial thromboplastin time (aPTT), and prothrombin time(PT) additionally can be done depending on the patient's history.

• Urinalysis is done in all the patients to check for urine infection, or to check for sugar and ketone bodies in the case of a diabetic patient.

Chest x-ray

A preoperative chest x-ray is done on every patient for assessment of cardiac or pulmonary sickness. It is also indicated for smokers, patients aged 60 years or older, and most cancer sufferers.

Electrocardiogram (ECG)

If the affected person has acknowledged or suspected cardiac sickness, an ECG is mandatory.

Diagnostic procedures

Special diagnostic tactics are carried out if particularly indicated e.g Doppler research for vascular surgery.

Written commands and consent

The affected person must get hold of written preoperative commands to comply with before admission for the surgical procedure. These commands and consent must be reviewed with the affected person inside the surgeon's workplace or inside the preoperative checking-out center.

Preoperative assessment is the cornerstone of safe surgical practice.

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