Preoperative patient assessment

A pre-op template can be found and downloaded here
Link includes a useful guide for chart review and how to assess relevant comorbidities

Don’t forget to include other pertinent studies, such as PFTs, TTE or stress echo results, Holter or Zio patch results, device interrogations, etc.
Check the media tab and care everywhere for outside studies
Review the Anesthesia tab in chart review to see prior anesthetics and airway/procedure notes
Add the “Pre-Admission/Pre-op Orders” set at your institution to your favorites, if applicable
- 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

To start, consider referring to WikiAnesthesia's article for the case at hand.
- If WikiAnethesia article not available, consider Jaffe’s Anesthesiologist’s Manual of Surgical Procedures, or talk with a senior resident
Who is the surgeon? What is the expected procedure duration?
Patient positioning
- This may affect your line and monitor placement
- May also have hemodynamic implications (e.g. steep Trendelenburg or reverse Trendelenburg)
Is special monitoring required?
- Is there an indication for an arterial or central line?
- Is there an indication for an EEG monitor (Sedline, BIS)?
- Is neuromonitoring part of the procedure plan?
Blood products
- Based on anticipated blood loss and patient’s pre-operative CBC, consider ordering blood products
Induction
- Choice of induction agent
- RSI vs standard
- Any relevant comorbidities that may change your induction plan (most commonly cardiac or pulmonary comorbidities)
Have a well-thought out airway plan, as well as a backup plan • Maintenance • Inhalational agent vs TIVA
Analgesia
- Anticipate need for pressors, fluid resuscitation, frequent labs
Emergence
- Anticipate need for a more controlled emergence (e.g. high risk for bleeding into an enclosed space)
- Consider the need for post-op intubation or monitoring in the ICU

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

Patients with PPMs and AICDs present unique management challenges
Important questions to ask about managing AICDs and pacemakers intra- operatively:
- What is the site of surgery? If above the umbilicus, there is a risk of interference
- Is the patient pacemaker dependent?
- What type of device does the patient have, and what were the results of the last interrogation?
- What effect will placing a magnet over the device have?
- Does the patient’s device need to be interrogated or reprogrammed before or after surgery?
When in doubt, best to contact the device rep
As a backup, you can also page the device management service at your institution