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Preoperative Assessment, Premedication & Monitoring

Anaesthetic drugs and techniques have profound effects on human physiology. Hence, a focused review of all major organ systems should be completed prior to surgery.
Goals of the preoperative evaluation is to ensure that the patient is in the best (or optimal) condition.
  1. Problem Identification
  2. Risk Assessment
  3. Preoperative Preparation
  4. Plan of Anesthetic Technique
  1. History
  2. Physical examination
  3. laboratory investigation


History of underlying disease, medication, functional capacitance, previous anesthetic history, family history, smoking and alcohol, allergy, Airway evaluation

Physical examination

Vital signs, General appearance, Respiratory system, CVS, Abdomen, Extremities and spine, Neurologic system.

Airway evaluation

  1. History of difficult intubation
  2. Head and neck examination for airway evaluation
  3. Face
  4. Oral cavity : mouth opening, mandibular space, tongue, teeth
  5. Mallampati classification
    Class I = visualize the soft palate, fauces, uvula, anterior and posterior pillars.
    Class II = visualize the soft palate, fauces and uvula.
    Class III = visualize the soft palate and the base of the uvula.
    Class IV = soft palate is not visible at all.
  6. Measurements 3-3-2-1
    3 Fingers Mouth Opening
    3 Fingers Hypomental Distance. (3 Fingers between the tip of the jaw and the beginning of the neck (under the chin)
    2 Fingers between the thyroid notch and the floor of the mandible (top of the neck)
    1 Finger Lower Jaw Anterior sublaxation

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