Anesthesia - Exam

Surgical history

• Any prior operations.

Drug history

• Reactions to anesthetic during previous operation.
• Family history of reaction to anesthetic (malignant hyperthermia).
• Drugs currently taking, took in past.
• Allergies to drugs: dye and esp. antibiotics that you might need [differentiating s/e from allergy very important here].

Cardiac

• Activity level.
• MI, angina.
• HTN.
• Murmurs.
• IE, prosthetic valve (antibiotic prophylaxis needed).
• Listen to heart sounds.
• BP.

Pulmonary

• Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew].
• Dyspnoea.
• Asthma, bronchitis, TB, CF.
• Chest infections.
• Listen to lungs.

Alimentary

• Inspect: is patient obese?
• Goitre (impinges airway).
• Operations on throat.
• Reflux problems, heartburn (aspiration risk).
• Seasickness in past (more likely vomiting from drugs).
• Dentures.
• Loose crowns, bridges.
• How far can pt open mouth?
• Pt sticks out tongue, Dr. looks at back of throat.
• Cervical injury
• Can pt touch chin to chest, move up and down.
• TMJ problems: never broken it, doesn't lock, doesn't click.
• How long have been fasting.
• Alcohol (heavy drinker needs more propofol).
• Speaking, throat problems [avoids post-op blame].

Nervous

• Epilepsy (propofol contraindicated).
• Other nervous disorders [avoids post-op blame].

Urogenital

• OCP
• No chance currently pregnant (drugs teratogenic and abortion risk, aspiration risk from morning sickness).

Anxiety level

• How do you feel about operation?
• If very anxious, give a benzodiazepene.