Thorough preoperative care is important for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship scheduled to undergo surgery so that they can have the best possible outcomes after their surgical procedure. The preoperative process begins once the decision has been made to proceed with a surgical procedure. In the case of elective surgeries, preoperative care is provided in an outpatient setting over several days to weeks prior to the surgery. For emergent surgeries, there may be limited time for preoperative evaluation and optimization in an inpatient setting. Preoperative assessment includes a thorough medical history, physical examination, risk assessment, and general and system-specific evaluations. The goal is to identify and address potential concerns prior to surgery and improve surgical outcomes.
Last updated: May 18, 2021
Preoperative care for elective surgical procedures is conducted in the outpatient setting.
Goals of the interview:
Medical history with emphasis on:
Physical examination:
Additional studies:
Most healthy patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship do not need additional preoperative evaluation.
The goal of screening is to identify patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with risk factors who may benefit from additional evaluation.
Specific factors that can influence postoperative outcomes:
Screening questionnaires:
Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with a history or symptoms suggestive of heart disease need further assessment. Multiple algorithms for risk assessment have been developed. The revised cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) risk index (RCRI) is the most practical and frequently used tool:
Low-risk patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship do not need further evaluation.
High-risk patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are classified based on functional capacity:
Very high-risk patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship:
All patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship should be asked about a history of bleeding disorders Bleeding disorders Hypocoagulable conditions, also known as bleeding disorders or bleeding diathesis, are a diverse group of diseases that result in abnormal hemostasis. Physiologic hemostasis is dependent on the integrity of endothelial cells, subendothelial matrix, platelets, and coagulation factors. The hypocoagulable states result from abnormalities in one or more of these contributors, resulting in ineffective thrombosis and bleeding. Hypocoagulable Conditions or the use of anticoagulants Anticoagulants Anticoagulants are drugs that retard or interrupt the coagulation cascade. The primary classes of available anticoagulants include heparins, vitamin K-dependent antagonists (e.g., warfarin), direct thrombin inhibitors, and factor Xa inhibitors. Anticoagulants. Perioperative management differs significantly and is dependent on the indication and type of anticoagulant.
The American Association for Anesthesiologists Anesthesiologists Physicians specializing in anesthesiology. Anesthesiology: History and Basic Concepts classification system stratifies patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship for postoperative outcomes based on health status:
Grade | Visible structures |
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Grade 1 | Fauces, pillars, soft palate Palate The palate is the structure that forms the roof of the mouth and floor of the nasal cavity. This structure is divided into soft and hard palates. Palate: Anatomy, and uvula Uvula A fleshy extension at the back of the soft palate that hangs above the opening of the throat. Peritonsillar Abscess |
Grade 2 | Fauces, soft palate Palate The palate is the structure that forms the roof of the mouth and floor of the nasal cavity. This structure is divided into soft and hard palates. Palate: Anatomy, and some part of the uvula Uvula A fleshy extension at the back of the soft palate that hangs above the opening of the throat. Peritonsillar Abscess |
Grade 3 | Soft palate Palate The palate is the structure that forms the roof of the mouth and floor of the nasal cavity. This structure is divided into soft and hard palates. Palate: Anatomy |
Grade 4 | Hard palate Palate The palate is the structure that forms the roof of the mouth and floor of the nasal cavity. This structure is divided into soft and hard palates. Palate: Anatomy only |
Provide maintenance fluid on the morning of surgery and continue intraoperatively: 1.5 mL/kg/hour will meet the maintenance fluid requirements for most patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship.
Medications | Recommendations |
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Cardiovascular medications |
Antihypertensives
Antihypertensives
The 1st-line medication classes for hypertension include thiazide-like diuretics, angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBS). Contraindications, adverse effects, and drug-to-drug interactions are agent specific.
Hypertension Drugs:
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H2 blocker or proton pump inhibitors Proton Pump Inhibitors Compounds that inhibit h(+)-k(+)-exchanging ATPase. They are used as anti-ulcer agents and sometimes in place of histamine h2 antagonists for gastroesophageal reflux. Gastric Acid Drugs | Continue therapy. |
Asthma medications Asthma medications Management of asthma aims to reduce symptoms and minimize future risks and adverse outcomes (hospitalizations, loss of lung function, etc.). Medications commonly utilized include inhalers that allow bronchodilation and inflammatory control. Biologic agents are available for severe asthma. Asthma Drugs |
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Antiplatelet drugs | Discontinue 1 week prior to surgery. |
NSAIDs NSAIDS Primary vs Secondary Headaches | Discontinue at least 3 days prior to surgery. |
Antidiabetic medications |
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Oral contraceptives | Discontinue 1 month prior to surgery. |
Psychotropic agents |
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Anticonvulsants | Continue therapy. |