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
- 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
- Anticipate need for pressors, fluid resuscitation, frequent labs
- 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
- 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