Perianesthesia Patient Assessment and Evaluation
Preoperative assessment
Begin with a structured history: allergies and reaction type, medications including anticoagulants and GLP-1 agonists, prior anesthetics, family history of malignant hyperthermia, comorbidities, functional capacity, and NPO status. Screen for obstructive sleep apnea with STOP-BANG and assess the airway (Mallampati, mouth opening, thyromental distance, neck mobility). Verify that the surgeon obtained informed consent; the nurse witnesses it, not obtains it.
Phase I and Phase II
Phase I is intensive, continuous monitoring: airway, respiratory rate, SpO2, capnography when indicated, ECG, blood pressure, temperature, sedation level, pain, surgical site, drains, and intake/output. Use a validated sedation scale such as POSS or RASS rather than documenting “sleeping comfortably.” Phase II prepares for discharge using objective criteria such as the Aldrete or PADSS score.
Traps
Questions often test NPO guidance: clear liquids 2 hours, breast milk 4 hours, infant formula and nonhuman milk 6 hours, light meal 6 hours, fatty meal 8 hours. Over-restriction is not best practice. Another trap is treating one normal vital sign set as adequate; assessment is continuous. Do not accept an unsigned consent or a consent signed while the patient is sedated.
Worked example
A patient with OSA on home CPAP arrives sleepy with SpO2 94% on room air. Normal room-air saturation does not exclude hypoventilation. Apply the home CPAP or provide positive pressure, monitor capnography, and do not rely solely on pulse oximetry.
Rule of thumb: document a baseline before sedation and compare every later finding to it.