https://wikianesthesia.org/w/api.php?action=feedcontributions&feedformat=atom&user=Alexmiller 2026-05-02T16:35:13Z User contributions MediaWiki 1.37.1 https://wikianesthesia.org/w/index.php?title=Preoperative_patient_assessment&diff=13852 2022-08-28T18:23:09Z

<p>Alexmiller: Link was broken. Updated it with a working link to the intended resource.</p> <hr /> <div>=== Chart Review ===<br /> <br /> * A pre-op template can be found and downloaded [https://ether.stanford.edu/ca1_new/ca1_preop_new1.html here]<br /> *Link includes a useful guide for chart review and how to assess relevant comorbidities <br /> <br /> === Preop Tips ===<br /> <br /> * Don’t forget to include other pertinent studies, such as PFTs, TTE or stress echo results, Holter or Zio patch results, device interrogations, etc. <br /> * Check the media tab and care everywhere for outside studies <br /> * Review the Anesthesia tab in chart review to see prior anesthetics and airway/procedure notes <br /> * Add the “Pre-Admission/Pre-op Orders” set at your institution to your favorites, if applicable<br /> ** You can use this order set for day-of-surgery labs, rapid COVID-19 testing, pre-op IV placement if appropriate, ordering blood products to be available in blood bank, and you can order PO analgesics to be given in pre-op<br /> <br /> === Anesthetic Plan ===<br /> <br /> * To start, consider referring to WikiAnesthesia's article for the case at hand.<br /> ** If WikiAnethesia article not available, consider Jaffe’s Anesthesiologist’s Manual of Surgical Procedures, or talk with a senior resident <br /> * Who is the surgeon? What is the expected procedure duration? <br /> * Patient positioning <br /> ** This may affect your line and monitor placement <br /> ** May also have hemodynamic implications (e.g. steep Trendelenburg or reverse Trendelenburg) <br /> * Is special monitoring required? <br /> ** Is there an indication for an arterial or central line? <br /> ** Is there an indication for an EEG monitor (Sedline, BIS)? <br /> ** Is neuromonitoring part of the procedure plan?<br /> * Blood products <br /> ** Based on anticipated blood loss and patient’s pre-operative CBC, consider ordering blood products <br /> * Induction <br /> ** Choice of induction agent <br /> ** RSI vs standard <br /> ** Any relevant comorbidities that may change your induction plan (most commonly cardiac or pulmonary comorbidities) <br /> * Have a well-thought out airway plan, as well as a backup plan • Maintenance • Inhalational agent vs TIVA <br /> * Analgesia <br /> ** Anticipate need for pressors, fluid resuscitation, frequent labs <br /> * Emergence <br /> ** Anticipate need for a more controlled emergence (e.g. high risk for bleeding into an enclosed space) <br /> ** Consider the need for post-op intubation or monitoring in the ICU<br /> <br /> === Ordering extra equipment ===<br /> <br /> * Consider whether your case will require additional equipment, such as a video laryngoscope, arterial line setup, special ETTs, etcetera and place the proper order for this equipment so it can be ready for your case in the morning<br /> <br /> === Device Management ===<br /> <br /> * Patients with PPMs and AICDs present unique management challenges <br /> * Important questions to ask about managing AICDs and pacemakers intra- operatively: <br /> ** What is the site of surgery? If above the umbilicus, there is a risk of interference <br /> ** Is the patient pacemaker dependent? <br /> ** What type of device does the patient have, and what were the results of the last interrogation?<br /> ** What effect will placing a magnet over the device have? <br /> ** Does the patient’s device need to be interrogated or reprogrammed before or after surgery? <br /> * When in doubt, best to contact the device rep <br /> * As a backup, you can also page the device management service at your institution</div>

Alexmiller