Pre-Anesthetic Checkup Components
A comprehensive pre-anesthetic evaluation must include medical record review, patient interview, focused physical examination (airway, lungs, heart, vital signs), and selective laboratory testing based on clinical indications—not routine screening—with timing determined by surgical invasiveness and patient disease severity. 1
Core Components of the Pre-Anesthetic Assessment
Medical Record Review
The pre-anesthetic evaluation begins with assessment of readily accessible medical records, which should document: 1
- Current diagnoses and medical conditions affecting anesthetic risk 1
- All medications including dosing, potential drug interactions, and perioperative adjustments needed 2
- Alternative therapies and supplements the patient is taking 1
- Previous anesthetic history, particularly any airway difficulties or adverse reactions 2
- Cardiac rhythm management devices (pacemakers/ICDs) with device type and pacemaker dependency 2
Patient Interview and History
The interview must specifically screen for: 2
- Obstructive sleep apnea by asking about snoring, apneic episodes, frequent arousals, morning headaches, and daytime somnolence 2
- Allergy history including anaphylactic reactions, latex allergy (especially in patients with spina bifida, multiple surgeries, healthcare workers, or fruit allergies to banana/chestnut/avocado), and drug allergies 2
- Cardiovascular and respiratory disease, which represent the most common sources of increased anesthetic risk 3
Focused Physical Examination
At minimum, the physical examination must include assessment of the airway, lungs, and heart with documentation of vital signs. 1 Specifically evaluate: 1, 2
- Airway examination (100% consensus among ASA consultants and members for high surgical invasiveness) 1
- Pulmonary examination including lung auscultation (88% consultants, 85% ASA members agree) 1
- Cardiovascular examination (81% consultants, 82% ASA members agree) 1
- Nasopharyngeal characteristics, neck circumference, tonsil size, and tongue volume 2
- Musculoskeletal abnormalities such as osteoarthritis, kyphoscoliosis, or fixed flexion deformities 2
- Baseline oxygen saturation if sleep-disordered breathing is suspected 2
Timing of Pre-Anesthetic Evaluation
High Surgical Invasiveness or High Disease Severity
For procedures with high surgical invasiveness OR patients with high severity of disease, perform the complete record review, patient interview, and physical examination prior to the day of surgery. 1 This represents 89% consultant and 75% ASA member consensus. 1
Low Surgical Invasiveness with Low Disease Severity
For patients with low disease severity undergoing procedures with medium or low surgical invasiveness, the initial interview and physical exam may be performed on or before the day of surgery. 1
Laboratory Testing Strategy
Order laboratory tests only when justified by specific clinical indications—routine preoperative screening tests are not recommended. 4 The evidence shows that in healthy ASA I-II patients, no deaths or major perioperative morbidities occurred in over 1,000 patients who underwent anesthesia without any preoperative laboratory testing. 5
Indicated Laboratory Tests
Order tests selectively based on these clinical indications: 2
Complete blood count (CBC): For patients with diseases increasing anemia risk, history of anemia, or when significant perioperative blood loss is anticipated 2
Electrolytes and creatinine: For patients with chronic disease and those taking medications predisposing to electrolyte abnormalities 2
Random glucose: For patients at high risk of undiagnosed diabetes 2
Coagulation testing (PT, aPTT, platelet count): Reserve for patients with history of bleeding, medical conditions predisposing to coagulopathy, or those taking anticoagulants 2
Timing of Laboratory Tests
In ASA I-II patients with normal results, laboratory blood tests performed up to 2 months before surgery are acceptable and do not require repeat testing. 6 Testing 2-3 months before surgery was associated with slightly increased odds of 30-day morbidity (P=0.002), suggesting this is the outer limit. 6
Electrocardiogram Considerations
Do not order routine ECGs without clinical indication. 1 The evidence shows: 1
- Routine ECGs were abnormal in 7.0-42.7% of cases but led to clinical management changes in only 9.1% of abnormal findings 1
- Indicated ECGs (ordered for specific clinical reasons) were abnormal in 4.8-78.8% of cases and led to management changes in 2.0-20.0% of abnormal findings 1
Common Pitfalls to Avoid
Do not order "preop status" or "surgical screening" panels—these are not considered specific clinical indications. 1 A thorough clinical assessment is more important than routine tests and eliminates unnecessary cost without compromising safety. 4
Ensure adequate time for evaluation. The healthcare system must provide pertinent information to the anesthesiologist for appropriate assessment well in advance of the anticipated procedure day for all elective patients. 1
Verify patient identity, correct surgical procedure, and correct surgical site while obtaining informed consent. 2 This is a fundamental safety requirement that must not be overlooked.