Preoperative Assessment, Patient Evaluation, and Anesthesia Planning
What you must understand
Preoperative assessment is risk stratification, not just paperwork. Take a focused history (comorbidities, prior anesthetics and complications, allergies, medications, substance use), perform a targeted examination (airway, cardiopulmonary, neurologic), and order only indicated tests. Know the ASA physical status classification and how it guides planning. Understand the implications of common conditions: ischemic heart disease, heart failure, COPD, asthma, diabetes, renal impairment, and obesity. Recognize difficult airway predictors (Mallampati, thyromental distance, mouth opening, neck mobility) and plan accordingly. Review anticoagulants and antiplatelets and know when to hold them based on bleeding risk versus thrombosis risk. Discuss aspiration risk and fasting guidelines. Document informed consent and the anesthetic plan.
Traps in questions
A frequent trap is ordering routine tests for every patient; testing should be driven by history and the planned procedure. Another is assuming a normal resting ECG excludes cardiac risk. Watch for questions that ask which single factor most increases perioperative risk-poor functional capacity and uncontrolled systemic disease usually trump age alone. Also distinguish an allergy from an intolerance or side effect.
Rule of thumb
Plan the anesthetic around the patient, the procedure, and the airway. If any one of these is high risk, escalate monitoring, personnel, and backup planning before induction.