What questions should be asked during preoperative evaluation of a patient?

Essential Questions for Preoperative Evaluation

A comprehensive preoperative evaluation should include specific questions about medical history, current medications, allergies, and previous surgical experiences to minimize perioperative morbidity and mortality. The following structured approach will help identify key risk factors and optimize patient outcomes.

General Health Assessment

• Current health status: "How would you rate your general health?" (Excellent/Good/Fair/Poor) 1
• Recent health changes: "Has there been a recent change in your health?" 1
• Functional capacity assessment: Can the patient perform activities equivalent to 4 METs (e.g., climbing a flight of stairs, walking up a hill) 1

Cardiovascular Assessment

• History of cardiovascular disease:

  • Hypertension
  • Coronary artery disease/previous heart attack
  • Heart failure
  • Arrhythmias
  • Previous cardiac interventions (stents, bypass surgery)
  • Peripheral vascular disease 1

• Specific cardiac symptoms:

  • Chest pain or angina (including atypical presentations like dyspnoea or epigastric pain)
  • Shortness of breath
  • Palpitations
  • Orthostatic hypotension
  • Exercise tolerance 1

Respiratory Assessment

• History of respiratory conditions:
  • Asthma
  • COPD
  • Sleep apnea (consider STOP-BANG assessment)
  • Recent respiratory infections 1

Endocrine Assessment

• Diabetes status:
  • Type and duration
  • Current management (diet, oral medications, insulin)
  • Recent blood glucose control
  • Presence of complications (neuropathy, nephropathy) 1

Medication Review

• Complete list of all medications:

  • Prescription medications with dosages and frequency
  • Over-the-counter medications
  • Supplements and herbal remedies 1

• Special attention to:

  • Anticoagulants (e.g., warfarin - requires special perioperative management) 2
  • Antiplatelets
  • Antihypertensives (particularly ACE inhibitors and angiotensin receptor blockers) 1
  • Hormone therapy 1

Allergy Assessment

• "Are you allergic or sensitive to any medications, adhesive tape, latex, or other substances?" 1
• Nature of allergic reactions (anaphylaxis, rash, etc.)

Previous Anesthetic Experience

• "Have you or any close relatives had problems with anesthetics or sedation?" 1
• Previous post-operative nausea/vomiting
• Previous difficult intubation

Pregnancy Status

• For patients with reproductive potential: "Is there any chance you could be pregnant?" 1
  • Note: This question should be asked in a non-gendered, factual manner to all patients who have the anatomical potential for pregnancy, including transgender and gender-diverse patients 1

Gender Identity and Special Considerations

For transgender and gender-diverse patients:

• Two-step approach: first asking about sex recorded at birth, then about gender identity 1
• Preferred name and pronouns
• Current hormone therapy
• Previous gender-affirming surgical procedures 1

Surgical Site-Specific Questions

For thyroid surgery:

• Communication with anesthesiologist about:
  • Abnormal vocal fold mobility
  • Ability to visualize the laryngeal inlet
  • Altered laryngeal anatomy
  • Hypopharyngeal crowding/compression
  • Whether nerve monitoring will be used 1

Patient Expectations and Concerns

• "What are your main concerns about the surgery?"
• "What questions do you have about the recovery process?" 3, 4
• "What are your expectations for mobility and self-care after surgery?" 4

Advance Directives

• "Do you have advance directives or a living will?"
• "Would you like information about advance directives?" 3

Common Pitfalls and Caveats

1. Inadequate medication review: Failure to identify all medications, particularly anticoagulants like warfarin, can lead to serious bleeding complications 2.

2. Missing cardiac risk factors: The revised cardiac risk index should be calculated for patients ≥50 years undergoing major surgery 1.

3. Overlooking special populations: Transgender and gender-diverse patients require sensitive, appropriate questioning about anatomical considerations that may affect perioperative care 1.

4. Poor communication with anesthesia team: Failure to communicate specific concerns (e.g., difficult airway, need for nerve monitoring) can lead to complications 1.

5. Neglecting patient expectations: Patients who don't understand what to expect postoperatively often experience greater anxiety and dissatisfaction 3, 5.

By systematically addressing these areas during preoperative evaluation, clinicians can identify risk factors, optimize medical conditions, and improve patient outcomes while reducing perioperative morbidity and mortality.