Preoperative assessment

Preoperative assessment is done based on

1. History
2. Physical Examination
3. Investigation

1. History


- Presenting complain
- Medical condition: CV/Respiratory/effort tolerance
- Anesthesia history: previous complication/ side effect: difficult airway/nausea/headache
- Family history: malignant hyperthermia/ porphyria/ pseudocholinesterase deficiency 
- Drug history: Anti-hypertensive/ steroids/ OCPs/ anti-convulsion
- Allergy: drug/food/soy
- Social History: smoking/alcohol

2. Physical examination


General: hydration/ temperature
CVS: Pulse/ JVP/ BP/ Heart sound/ Murmur - AS(lean in front) /MS(lean laterally)
Respiatory: Cyanosis/ Auscultation of lungs
Airway: Mallampati score, thyromental distance, neck movement, facial symmetry, tongue size

Mallampati score
Grade 1- full opening
Grade 2- tongue touches tip of uvula
Grade 3- Tongue covering tip of uvula
Grade 4- Tongue covering everything

Thyromental distance (<7cm : suggest difficult airway)

3. Investigation


- FBC: all
- Urinalysis: all
- RF : hx of diarrhea/vomiting/ renal disease
- LFT: liver disease/ alcoholism / nutritional state
- Blood glucose: DM/ vascular disease/ corticosteroid 
- Coagulation profile: coagulation disorder/ chronic liver disease
- ECG: >45 CVS disease
- CXray: Respiratory problem/ Thyroid enlargement


American Society of Anesthesiologists grading (ASA)


Grade
1. Healthy
2. + Disease controlled/ non life threatening
3. + Disease uncontrolled/ non life threatening
4. +  Life threatening
5. Expect to die with or without surgery
6. Dead - for organ donation