Preoperative Assessment Guidelines for Elective Procedures
Essential Components of Preoperative Assessment
- The American Society of Anesthesiologists recommends assessing ASA physical status, age, sex, and type of surgery planned to identify risk factors for perioperative complications 1
- Patients should be screened for gastroesophageal reflux disease, dysphagia, gastrointestinal motility disorders, and metabolic conditions like diabetes mellitus that may increase aspiration risk 1, 3
- Evaluate for functional dependence, chronic obstructive pulmonary disease, congestive heart failure, weight loss, and obstructive sleep apnea, which are significant risk factors for postoperative pulmonary complications 4
- Review smoking and alcohol consumption history, as cessation at least 4 weeks before surgery can reduce respiratory and wound-healing complications 5
Laboratory Testing
- A complete blood count (CBC) is indicated for patients with a history of anemia or recent blood loss, liver disease or other hematologic disorders, and those undergoing cardiovascular or major surgery 2
- Electrolyte and renal function testing is recommended for patients with known renal conditions, undergoing neurosurgery or cardiovascular surgery, and those taking medications that affect electrolytes 2, 6
Preoperative Fasting Guidelines
- The American Society of Anesthesiologists recommends that clear liquids may be ingested up to 2 hours before procedures requiring general anesthesia, regional anesthesia, or procedural sedation 1, 3
- Breast milk may be ingested up to 4 hours before elective procedures, and infant formula may be ingested up to 6 hours before elective procedures 3
Cardiovascular Assessment
- An ECG is indicated for patients with signs or symptoms of cardiovascular disease and those undergoing high-risk surgery 6
- Patients with good functional capacity (≥4 METs or ability to climb ≥2 flights of stairs) generally can proceed to surgery without further cardiac testing 6
Pulmonary Assessment
- Chest radiography is not recommended routinely for asymptomatic patients, but may be considered for patients with new or unstable cardiopulmonary symptoms 6
Anemia Screening and Management
- Screen for anemia at least 4 weeks before elective surgery to allow time for evaluation and treatment, and assess iron status using serum ferritin and transferrin saturation 7
- For moderate-to-severe anemia, intravenous iron therapy is preferred, especially when surgery is scheduled within 2-3 weeks 7
Preoperative Patient Education
- Provide preoperative counseling about the surgical and anesthetic procedures to reduce anxiety and enhance recovery, and inform patients of fasting requirements and the reasons for them sufficiently in advance 1, 9