Preoperative patient assessment

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Chart Review

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

Preop Tips

  • 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

Anesthetic Plan

  • 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

Ordering extra equipment

  • 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

Device Management

  • 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