During Pre-op, patients will be nervous and will have given their histories already to several providers before you. Therefore, anesthesia histories should be extremely focused. At the same time, you must quell your patient's fears and give them confidence in their care team, so rapport is extremely important.
The following information should be elicited:
- Patient Name:
Surgical History: Especially interested in procedures that may affect cardiopulmonary physiology (e.g cardiac procedures, pneumenectomy) or spine mobility (e.g. cervical fusion).
History of problems with anesthesia: e.g. Post operative nausea and vomiting, Difficult placement of breathing tube, Delayed emergence, Awareness, Malignant Hyperthermia**
Drug Allergies and type of reaction: Specifically note egg allergies (Propofol exists in an egg-white emulsion). Allergies to chemicals that the body produces endogenously (e.g. epinephrine) should be taken with a grain of salt.
Current Medications and Doses: Confirm information if available in patient's chart.
Last time medications were taken: Consult Medication Discontinuation Guidelines.
Last meal: Consult NPO guidelines but, in general, patients should not have anything to eat in the last 8 hours.
Smoking history: _ packs/day for _ years. Smokers will have greater secretions (can be reduced with glycopyprolate) and may be more difficult to ventilate due to COPD.
Alcohol Use: Acute alcohol use reduces dose of sedative agents required. Chronic Alcohol use raises dose of sedative agents required.
Recreational Drug Use: Particularly interested in cocaine use as may cause intra-op hypertension that will be worsened by administration of most beta blockers (due to unopposed alpha agnoism).
Can you walk up 2 flights of stairs without feeling out of breath? 2 Flights of stairs = same cardiac demand as receiving general anesthesia.
Do you have any problems with your lungs? e.g. Asthma, COPD, Snoring, TB
- If Asthma, ask how often albuterol is needed. Also ask about possible hospitalizations and intubations. If asthma history is alarming, nebulized albuterol will be provided prior to surgery.
If snoring, ask if patient has received a sleep study (official diagnosis), and whether they use a CPAP at home.
Do you have any problems with your heart? e.g. Hypertension, Coronary Artery Disease, Peripheral Artery Disease, Diabetes, Stroke.
- If they do, calculate their Revised Cardiac Risk Index to determine risk of intraoperative heart attack.
- If they have stents, go through this flowchart to make sure they are adequately anticoagulated.
If they have an ICD or Pacemaker, run through this flowchart to determine how to manage the device intraoperatively.
Do you or does anyone in your family have serious bleeding problems?
Do you have any chipped or loose teeth, dentures, caps, bridgework, braces, problems opening your mouth or swallowing, or choking while eating? If patient is missing any teeth at all, ask them to physically feel their teeth to ensure they are not loose.
Have you ever had problems with:
- Liver (Cirrhosis, Hepatitis A,B,C, Jaundice)
- Kidney (stones, failure, dialysis)
- Digestive System (frequent heartburn, hiatal hernia, stomach ulcer)
- Back, Neck or Jaws (TMJ, Rheumatoid Arthritis, Herniation)
- Thyroid Gland (underactive or overactive).
Have you ever had:
- Stroke, facial, leg or arm weakness, difficulty speaking
- Crampng pain in your legs with walking?
- Problems with hearing, vision or memory?