An 80 years old man was diagnosed with bladder cancer and he was scheduled for surgery to remove the tumor. So before going to surgery, basically there are few steps that have to be check to ensure the operation and the recovery of the patient going to as plan.
These steps are carried out by the mastermind of the operation, the anesthetist. Anesthetist is the person who ensures the patient is in optimal condition before entering the operating theatre.
For the purpose of discussion, let us divide it into:
-pre-operative assessment in history taking
-pre-operative assessment in physical examination
-pre-operative assessment in laboratory evaluation
Pre-operative assessment in history taking
Pre-operative assessment in physical examination
In physical examination, it starts with the general examination. It comprises the general appearance of the patient. Observe for any signs of pallor, cyanosis, jaundice and oedema. Look for patient body size and most important, the BMI of the patient.
Then, take the vital signs parameters such as blood pressure value, respiratory rate and temperature.
After general inspection, move to other relevant systems such as cardiovascular and respiratory examination. Listen to the sound of s1 and s2 heart sound as well as the breath sound using a stethoscope.
One examination that compulsory is airway examination. In this examination, the anesthetist will have a look at the chin size (for micrognathia), neck for its mobility, any swelling or abnormality and oral cavity. For oral cavity, things such as mouth opening, state of dentition and size of the tongue must be noted. There is one classification called Mallampati classification, used to predict the ease of intubation.
Finish with that, next is an examination at the site of anaesthetic drug administration such as spine for spinal or epidural analgesia.
Pre-operative assessment in laboratory evaluation
Currently, there is a lot of laboratory investigation that can be performed. But, it is not cost effective to perform all the test for all patient. There is a recommendation from Chapter of Anaesthesiologists, Academy of Medicine Malaysia stated that screening tests are based on patient’s age. The pecific test can be ordered according to patient’s medical condition.
All of these assessments are important to determine the anesthetic technique suitable for the patient as well as during the perioperative care. During this visit, developing a good rapport between anesthetist and patient is crucial as to reduce the preoperative anxiety. As a normal human being, we have this anxiety within ourselves. After deciding on the type of anesthetic technique, it is their job to inform and educate the patient about the anesthesia, perioperative care and pain management. It is time to discuss the anesthetic risks and obtain consent for anesthesia.
Before the surgery, the patient must fast overnight or at least 6 hours. The reason is to prevent the pulmonary aspiration of stomach contents during the anaesthesia. The patient can also be given anxiolytic to reduce the anxiety. Ranitidine (H2 antagonist), omeprazole (proton pump inhibitor) and metoclopramide can be given to increase the stomach pH and reduce the volume of gastric emptying.
After all the investigations have been reviewed by the anaesthetist, and they satisfied, only then the patient can proceed with the operation.