The pre-operative assessment  is an opportunity to identify co-morbidities that may lead to patient complicationsduring the anaesthetic, surgical, or post-operative period. Patients scheduled for elective procedures will generally attend a pre-operative assessment 2-4 weeks before the date of their surgery.

Pre-Operative History

The pre-operative history follows the same structure as typical history taking, with the addition of some anaesthetic and surgery specific topics.

History of the Presenting Complaint

A brief history of why the patient first attended and what procedure they have subsequently been scheduled for. One should also confirm the side on which the procedure will be performed (if applicable)

Past Medical History

A full past medical history (PMH) is required, with the following specifically asked about:

Cardiovascular disease (including hypertension and exercise tolerance)

The risk of an acute cardiac event is increased during anaesthesia

Respiratory disease, as adequate oxygenation and ventilation is essential in reducing the risk of acute ischaemic events in the peri-operative period

Renal disease, as many features of renal disease (such as anaemia, coagulopathy, biochemical disturbances) can increase the incidence of surgical complications

Endocrine disease, specifically diabetes mellitus and thyroid disease

Many medications often require specific changes to be made in the peri-operative period

Other specific questions it may be useful to ask themselves the following questions:

Female of reproductive age – could they be pregnant

African or Afro-Caribbean descent – could they have undiagnosed sickle cell disease

Past Surgical History

Has the patient had any previous operations? If so, what, when, and why?

Past Anaesthetic History

Has the patient had anaesthesia before? If so, were there any issues? Were they well intra- and post-operatively? Specifically, has the patient experienced to any previous post-operative nausea and vomiting?

Drug History

A full drug history is required, as some medications require stopping or altering prior to surgery. Ask about any known drug allergies.

Family History

An important condition to ask about is malignant hyperpyrexia* (also known as malignant hyperthermia), yet any other adverse reactions in surgery of immediate family members should also be documented.

An autosomal dominant condition that characteristically leads initially to muscle rigidity (despite neuromuscular blockade) followed by a rise in temperature (requires senior input and support if present)

Social History

Ensure to ask the patient about smoking history and alcohol intake and their exercise tolerance.

Pre-Operative Examination

Blood Tests

Full Blood Count (FBC)

Most patients will get a full blood count, predominantly used to assess for any anaemia or thrombocytopenia, as this may require correction pre-operatively to reduce the risk of cardiovascular events

Urea & Electrolytes (U&Es)

To assess the baseline renal function, which help inform any potential IV fluid management intra- and post-operatively

Liver Function Tests (LFTs)

Important in the assessing liver metabolism and synthesising function, useful for peri-operative management; if there is suspicion of liver impairment, LFTs may help direct medication choice and dosing

Clotting Screen

Any indication of deranged coagulation, such as iatrogenic causes (e.g. warfarin), inherited coagulopathies (e.g haemophilia A/B), or liver impairment, will need identifying and correcting before surgery

Group and Save (G&S) +/- cross-matching