Preoperative assessment of the orthopaedic patient

Preoperative assessment should identify and quantify medical problems so that the anaesthetic plan can be modified to reduce perioperative morbidity and mortality. Orthopaedic surgery presents specific challenges as well as having a high number of elderly patients. Cardiovascular problems are a leading source of mortality. The measurement of the patient's functional capacity (in terms of metabolic equivalents) is a useful tool for assessing his or her ability to meet the increased metabolic demands caused by surgery. Various risk scoring systems are used to quantify the perioperative risk, and predictors of risk have been identified. Further investigation and treatment may need to be considered before surgery, but these may have their own inherent risks. Clinical investigations should be ordered only if the results would change the anaesthetic technique. Patients undergoing surgery for fractured neck of femur have particularly high mortality (as high as 13%). Careful assessment should be undertaken, with attention given to fluid loss and replacement, a cause for the fall and other consequences of the fall. Rheumatoid arthritis poses a number of challenges. Systemic manifestations and side effects of medication can cause multisystem pathology. The condition is associated with difficult intubation. Involvement of the cervical spine can result in instability, and atlantoaxial instability needs to be investigated and discounted.