Pre Anesthesia Management and Premedication: Dr. Santosh Khadka Assistant Prof Naihs 2073/11/26

PRE ANESTHESIA MANAGEMENT
AND PREMEDICATION
Dr. Santosh Khadka

Assistant Prof
NAIHS
2073/11/26
1
What we are covering?
Definition
Aim
History taking
Examination: general/ systemic/airway
Investigations: routine / esp.
ASA Grading (Risks analysis )
Modification in pre-existing medical Rx
Optimization & Planning
Premedication
2
Definition :
The process of clinical assessment that
precedes the delivery of anesthesia care for
surgery or non surgical procedures.
PAC consists of the consideration of

information from multiple sources: include
the Pts. Interview, Medical records, Physical
examination & finding from medical tests and
evaluation.
3
Aim
To obtain brief medical and surgical history
To perform examination and needed Invs.
To reduce anxiety and educate the pts.

about anesthesia .
To make a rapport with pt.
4
To identify the risk of anesthesia and surgery
(ASA grading )& optimization of risk factor
To obtain informed written consent
To plan anesthetic technique
5
History
Demographic details
Regarding surgery
Co morbidities
Routine medication
Allergy
Personnel habits 6
Previous anesthesia exposure.
Family history
Airway & spine
Last oral intake / NPO time
7
Examination
General & Physical- vital signs, JALCCOD
Systemic CVS ,RESP,NERVOUS & others
Airway MPG,TOOTH, TMJ,THYROMENTAL

DISTANCES, NECK MOVEMENT, TRACHEAL
POSITION
Esp. Spine , Regional areas & veins
8
Respiratory system-
Chest movement &deformities,
Rate
Auscultation
Special examination: Breath holding time,
Match stick test, PFT
( COPD, LUNG ABCESS, INTERSTITIAL
PERENCHYMAL LUNG DISEASE, EFFUSION)
9
Cardiovascular System:
Heart rate& rhythm, BP, Neck veins
Auscultation
( HTN, Valvular Heart Disease, IHD, Failure, AF
& Blocks, Interventions)
CNS-
Epilepsy, ICP, Motor &Sensory Disorders
10
Endocrine :
DM- Types, duration& sign of Neuropathy,
PRIDICT DIFFICULT AIRWAYS
Thyroid- hypo or hyper
Adrenal-
Parathyroid-
Pituitary-
11
Hepatobiliary
Gastrointestinal
Renal
Musculoskeletal
Hematology & Immune system
12
Airway Examination
History- Past anesthetic exposure
Examination Pts. Features:
Faces, Necks, Mouth opening,
Teeth, Tongue
Thyromental distances
TMJ
Mallampati grading
13
Mallampati grading: On 1985 . Pt. keep on
same level of examiner neutral position with
max. mouth opening with protruding tongue
out side: faucial pillar, soft palate, uvula.
14
Investigations
Screening routine investigations:
To identification & discovery of disease or

disorders
To verification or assessment of already

known disease
15
Normally ASA I Pts. Below 40 yrs- CBC,
URINE R/E .
ASA II Or Above 40 yrs CBC, Blood

Biochemistry, ECG, CXR & other needed INVs
Special INVs- ECHO, PFT, TMT, TFT, ABG,

special Images
16
Preoperative status
Risk analysis :
ASA grading
P1- A normal healthy Pt.
P2- A pt. with mild systemic disease
P3- A Pt. with moderate to severe systemic

disease having functional limitation
17
P4- A Pt. with severe systemic disease having
functionally incapacitate that constant threat
to life.
P5- A moribund Pt. who is not expected to

survive with or without operation.
P6- Brain dead Pts. (organ donation)

Prefix E- emergency.
18
Modification in pre existing medical
therapy
To be continued or stopped
New medication when required
Anti hypertensive drugs, Insulin, OHG, Anti

platelets , Anticoagulants, anti depressants,
Anti epileptics , Steroids, Antibiotics
19
Optimization & Planning
After optimization of Pt. before operation
will minimizing morbidities & mortalities
And improves peri & post operative care.
Anesthesia counseling: Possible details about

anesthesia & obtaining written informed
consent.
20
Anesthesia Plan
NPO Hours before surgery
Adult - Child / Solid liquid food
Types of anesthesia:
G/A Induction, Airway,
Maintenance, Muscle relaxant
REGIONAL- Techniques, agents,
MAC- Monitoring, sedation
21
Intraoperative Mx-
Monitoring, positioning, fluid mx, special
techniques
Post operative Mx-

Pain control, Intensive care, Mechanical
ventilation
22
PREMEDICATION
To reduce anxiety
To produce hemodynamic stability
To induce sedation & decrease metabolic rate
To provide analgesia
To provide retro-grade amnesia

23
To decrease the chances of aspiration
(Decrease acidity& Vol. of gastric content)
To control secretion-oral& resp
To prevent PONV
To control infection
To reduce the doses of anesthetic drugs.

24
Commonly use drugs
Benzodiazepam- Diazepam, Midazolam,

Alprazolam, lorazepam
Alfa 2 agonist- Clonidine, Dexmedetomidine
Opioids- Morphine, Pethidine, fentanyl
25
Anti emetics- Metochlopramide,
Domperidone, Ondensetron, Granisetron
Anti sialagouge/ Anti cholinergic- Atropine,

Glycopyrrolate
Anti biotic
26
THANK YOU
27

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PRE ANESTHESIA MANAGEMENT

Dr. Santosh Khadka

PAC consists of the consideration of

To perform examination and needed Invs.

To reduce anxiety and educate the pts.

To make a rapport with pt.

To obtain informed written consent

To plan anesthetic technique

Airway & spine

Last oral intake / NPO time

Systemic CVS ,RESP,NERVOUS & others

Airway MPG,TOOTH, TMJ,THYROMENTAL

Hematology & Immune system

To identification & discovery of disease or

To verification or assessment of already

ASA II Or Above 40 yrs CBC, Blood

Special INVs- ECHO, PFT, TMT, TFT, ABG,

P2- A pt. with mild systemic disease

P3- A Pt. with moderate to severe systemic

P5- A moribund Pt. who is not expected to

P6- Brain dead Pts. (organ donation)

New medication when required

Anti hypertensive drugs, Insulin, OHG, Anti

Anesthesia counseling: Possible details about

Post operative Mx-

To produce hemodynamic stability

To induce sedation & decrease metabolic rate

To provide retro-grade amnesia

To reduce the doses of anesthetic drugs.

Benzodiazepam- Diazepam, Midazolam,

Alfa 2 agonist- Clonidine, Dexmedetomidine

Opioids- Morphine, Pethidine, fentanyl

Anti sialagouge/ Anti cholinergic- Atropine,

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