Anesthetics: History, Exam
- Surgical history
- Drug history
- Anxiety level
- Reactions to anesthetic during previous operation.
- Family history of reaction to anesthetic (malignant hyperthermia).
- Drugs currently taking, took in past.
- Allergies to drugs: dye and esp. antibiotics that you might need
[differentiating s/e from allergy very important here].
- Activity level.
- MI, angina.
- IE, prosthetic valve (antibiotic prophylaxis needed).
- Listen to heart sounds. See Cardiac
- Smoking: ever smoked, how many per day, for how long, type [cigarette,
- Asthma, bronchitis, TB, CF.
- Chest infections.
- Listen to lungs. See Lung
- Inspect: is patient obese?
- Goitre (impinges airway).
- Operations on throat.
- Reflux problems, heartburn (aspiration risk).
- Seasickness in past (more likely vomiting from drugs).
- Loose crowns, bridges.
- How far can pt open mouth?
- Pt sticks out tongue, Dr. looks at back of throat.
- Cervical injury
- Can pt touch chin to chest, move up and down.
- TMJ problems: never broken it, doesn't lock, doesn't click.
- How long have been fasting.
- Alcohol (heavy drinker needs more propofol).
- Speaking, throat problems [avoids post-op blame].
- Epilepsy (propofol contraindicated).
- Other nervous disorders [avoids post-op blame].
- No chance currently pregnant (drugs teratogenic and abortion risk,
aspiration risk from morning sickness).
- How do you feel about operation?
- If very anxious, give a benzodiazepene.