Criteria for Pre operative Assessment by an Anesthesiologist
  1. All ASA Class III or IV patients
  2. Patients over 70 years of age.
  3. All Insulin Dependent Diabetic patients.
  4. There is uncertainty whetehr the general anaesthetic patient is an ASA Class II or III
  5. Any condition limiting flexion and extension of the neck or mobility of the jaw.
  6. The patient gives a history of:
    1. difficult with anesthesia in the past i.e. difficult intubation
    2. diagnosis of malignant hyperthermia;
    3. unscheduled Intensive Care Unit (ICU) admission post-operatively;
    4. muscle weakness (hours) post-operatively;
    5. any adverse cardiac or respiratoyr event i.e. cardiac arrhythmia
    6. awareness during a previous general anaesthetic
    7. heartburn or acid regurgitation or hiatus hernia
    8. bleeding disorder
    9. high opiate use (i.e. morphine 60 mg/day)
  7. The pulse rate is irregular or less than 60 in non-athletes or greater than 90 after repeating at least once before an ECG is done.
  8. The patient's ECG is abnormal.
  9. 9. The pateint is on any monoamaine oxidase inhibitors (MAO), St John's Wort, Yohimbie, or Passion Flower.
  10. The patient is taking oral steroids and/or anticoagulants.
  11. The patient is morbidly obese as calculated using the body mass index (BMI > 35) as a guideline.
  12. The patient is pregnant.
  13. The patient is diagnosed with sleep apnea.
  14. Paedriatrics:
    1. a) any child age 6 or under
    2. b) dental restorations
    3. c) any major surgeries
    4. d) all neuro surgery
    5. e) ASA II, III and IV
  1. The patient is booked for any of the following surgeries:
    1. General Surgery
      1. major gastro-intestinal surgery;
      2. hiatus hernia repair (fundoplication)
      3. portovenous decompression
      4. thyroid surgery
    2. Urological Surgery
      1. cystectomy
      2. ileal conduit
      3. nephrectomy
      4. postatectomy (radical)
      5. transurethral resection of prostate (TURP)
    3. Neurosurgery
      1. craniotomy
      2. cervical spinal surgery
      3. lumbar or thoracic laminectomy (3 levels or more)
    4. Orthopaedic Surgery
      1. major spinal surgery
      2. total joint replacement surgery
      3. cervcial spinal fusion
      4. major orthopedic oncological surgery
    5. Cardiac Surgery
      1. all cardiac surgery
    6. Vascular Surgery
      1. all arterial vascular surgery
    7. Gynecology/Oncology
      1. pelvic exenteration
      2. radical hysterectomy
      3. defulking ovarian cancer
    8. ENT
      1. thyroidectomy

     

    Links:
     

    Evidence Footnotes:
    1. reference

American Society of Anaesthesiologist (ASA) Classification of Patients
Class I A normally health patient
Class II A patient with mild systemic disease
Class III A patient with severe systemic disease
Class IV A patient with severe systemic disease that is a constant threat to life
Class V A moribund patient who is not expected to survive without the operation
Authorship: Dr John Wells Last Revised: 8 July 2002
 
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