Preprocedure Assessment and Preparation
The purpose of the preprocedure visit
Preprocedure assessment answers three questions: is the patient optimized, is the planned anesthetic/sedation appropriate, and is the environment ready. Expect questions on ASA physical status (1 healthy; 2 mild systemic disease; 3 severe systemic disease; 4 severe disease that is a constant threat to life; 5 moribund; 6 organ donor; suffix E for emergency).
Core content areas
- Fasting (ASA): 2 h clear liquids, 4 h human breast milk, 6 h light meal or nonhuman milk/infant formula, 8 h fatty meal or meat. Clear liquids means water, pulp-free juice, clear tea/coffee without milk, and carbohydrate drinks.
- Airway screening: Mallampati class, mouth opening, thyromental distance, neck mobility, dentition, history of difficult intubation or obstructive sleep apnea. STOP-BANG ≥3 is intermediate, ≥5 high risk.
- Medication reconciliation: anticoagulants/antiplatelets, insulin and oral hypoglycemics, GLP-1 receptor agonists, beta blockers, ACE inhibitors, and home oxygen. Distinguish "hold" from "continue."
- Records: informed consent, allergies (and reaction type), NPO status, baseline vital signs, weight, pregnancy screening per policy, site marking, implant/device history (pacemaker, MH susceptibility).
Traps candidates miss
Confusing "light meal" with "any meal"; applying 8-hour fasting to clear liquids; assuming aspirin must always be stopped; reciting ASA class 3 as "mild" disease; forgetting that a documented difficult airway changes the plan even when the patient looks easy.
Rule of thumb
Say the sequence out loud: 2-4-6-8 for clear liquids, breast milk, light meal, fatty meal. Worked example: a patient drinks black coffee at 06:00, eats toast at 07:00, and is scheduled at 13:00 - both intervals (7 h and 6 h) are met, so fasting is adequate.