Preoperative assessment

This article discusses the rationale for preoperative anaesthetic assessment and how it should be performed. The role of the preoperative assessment and how it relates to preoperative screening, the anaesthetic history and examination, appropriate basic and advanced investigations, tools for risk assessment, methods of risk reduction (including anaesthetic planning), referral to specialist teams and premedication are also discussed. The article describes a focused anaesthetic history and examination, and concentrates on the areas that reflect the greatest anaesthetic risk. Appropriate preoperative investigations and some advanced tests are also discussed. The process of planning anaesthesia with the involvement of the patient, and the involvement of the healthcare team in major changes to the surgical plan is detailed. Risk assessment tools are such as the ASA scoring system and the concept of METs for non-cardiac surgery are described. The conditions that may undergo medical optimization by specialist teams are described. Premedication and its changing role are discussed in the final section of the article, highlighting the historical approach to premedicant drugs, how this approach has changed, and why.