Preanesthesia assessment is the process of clinical evaluation prior to the delivery of anesthesia in patients undergoing both surgical and nonsurgical procedures. This process includes interviewing the patient, reviewing the patient’s medical records, performing a physical examination, including an airway examination, ordering and/or reviewing relevant medical tests, and consulting other medical subspecialists as necessary. The goals of preanesthesia evaluation include familiarizing the provider with the patient’s medical conditions, determining the severity of illness, and confirming optimization of all identified issues.
Anesthesia providers should, at a minimum, perform a pulmonary, cardiovascular, and an airway evaluation. The patient’s vital signs should also be noted. Evaluation of other organ systems may be necessary depending on the patient’s current comorbidities.
Evaluate for presence of peripheral venous sites; for regional blocks, examine the extremity or the back for presence of infection or distorted anatomy.
Assess baseline level of consciousness and deficits if the patient has had prior neurologic disease (stroke, neuropathies, etc).
Auscultate for heart rate, rhythm, and presence of murmurs; note baseline heart rate and blood pressure (Table 62-1).
TABLE 62-1Heart Murmurs ||Download (.pdf) TABLE 62-1 Heart Murmurs
|Systolic Murmurs |
|Ejection-type || |
Aortic outflow tract
Aortic valve stenosis
Hypertrophic obstructive cardiomyopathy
Aortic flow murmur
Pulmonary outflow tract
Pulmonic valve stenosis
Pulmonic flow murmur
|Holosystolic || |
Ventricular septal defect
|Late-systolic ||Mitral or tricuspid valve prolapse |
|Diastolic Murmurs |
|Early diastolic || |
Aortic valve regurgitation
Pulmonic valve regurgitation
|Mid-to-late diastolic || |
Mitral or tricuspid stenosis
Flow murmur across mitral or tricuspid valves
|Continuous || |
Patent ductus arteriosus
Coronary AV fistula
Ruptured sinus of Valsalva aneurysm
Auscultate for rales, rhonchi, and wheezing, especially in patients with known pulmonary disease. Note baseline respiratory rate and O2 saturation at room air.
Look for clinical signs that predict difficult airway management. Evaluation of the airway includes, but is not limited to, assessing the thyromental distance and cervical spine flexion/extension, examining the oral cavity (Table 62-2) and assigning a Mallampati Classification (Figure 62-1 and Table 62-3). If a difficult airway is anticipated, additional assistance and alternative equipment should be readily available.
TABLE 62-2Elements of Airway Examination ||Download (.pdf) TABLE 62-2 Elements of Airway Examination
|Airway Examination ||Non-reassuring Finding |
|Teeth ||Edentulous |
|Length of upper incisors ||Relatively long |
|Relation of maxillary and mandibular incisors during normal jaw closure ||Prominent ...|