Anaesthesia: Introduction and preoperative assessment
In the first of a four part series, Jonathan Behar and colleagues tell us how to assess patients in the lead up to an operation
Inducing a state of unconsciousness is dangerous without correct preparation, and it is the role of the anaesthetist to assess and optimise the patient's fitness before their operation. An anaesthetist is also responsible for safe induction into, maintenance of, and emergence from anaesthesia and for postoperative care (including sufficient pain management). In this series we explore preoperative, perioperative, and postoperative care and look at regional anaesthesia. Other key roles of the anaesthetist, such as pain management and intensive care, are covered elsewhere.
History and examination are crucial in the anaesthetic assessment, as are the appropriate investigations, which depend on the patient's perceived health. These will guide the type of anaesthesia and the timing of surgery. An anaesthetist should have an overall picture of the patient's anaesthetic risk, and any comorbid conditions should be optimised before surgery.
In addition to this score, the Goldman cardiac risk index assesses the likelihood of