Anaesthetics Pre-Op Assessment 🩺
Pre-operative assessment template: ASA and Mallampati classification, history, examination, and investigations for NCHDs.
📋 Purpose
- Structured pre-op assessment to document fitness for anaesthesia, identify risk, and ensure key information is available for anaesthetics.
- Use as a template for clerking; refer to anaesthetics when optimisation, complex decisions, or formal review are needed.
ASA Physical Status Classification
- Assign based on patient’s physiological state and comorbidities (not the procedure). Document in notes.
I
- Description
- Normal healthy patient
II
- Description
- Patient with mild systemic disease (e.g. well-controlled hypertension, diet-controlled diabetes, smoking)
III
- Description
- Patient with severe systemic disease that is not life-threatening (e.g. stable angina, COPD, obesity BMI 30–40)
IV
- Description
- Patient with severe systemic disease that is a constant threat to life (e.g. unstable angina, sepsis, significant cardiac dysfunction)
V
- Description
- Moribund patient not expected to survive without the operation
VI
- Description
- Declared brain-dead patient whose organs are being removed for donor purposes
| ASA | Description |
|---|---|
| I | Normal healthy patient |
| II | Patient with mild systemic disease (e.g. well-controlled hypertension, diet-controlled diabetes, smoking) |
| III | Patient with severe systemic disease that is not life-threatening (e.g. stable angina, COPD, obesity BMI 30–40) |
| IV | Patient with severe systemic disease that is a constant threat to life (e.g. unstable angina, sepsis, significant cardiac dysfunction) |
| V | Moribund patient not expected to survive without the operation |
| VI | Declared brain-dead patient whose organs are being removed for donor purposes |
Mallampati Airway Assessment
- Patient sitting, mouth open fully, tongue out, no phonation. Assign grade; document in notes. Higher grade suggests potentially difficult intubation.
I
- Structures Visible
- Soft palate, fauces, uvula, anterior and posterior pillars
II
- Structures Visible
- Soft palate, fauces, uvula
III
- Structures Visible
- Soft palate, base of uvula
IV
- Structures Visible
- Hard palate only (soft palate not visible)
| Grade | Structures Visible |
|---|---|
| I | Soft palate, fauces, uvula, anterior and posterior pillars |
| II | Soft palate, fauces, uvula |
| III | Soft palate, base of uvula |
| IV | Hard palate only (soft palate not visible) |
📝 History to Document
- Patient identifiers: name, DOB, location, MRN. Planned procedure and urgency (elective / urgent / emergency).
- Past medical history: cardiac, respiratory, renal, diabetes, OSA, previous anaesthetics (including problems or difficult airway).
- Current medications: anticoagulants, antiplatelets, diabetic meds, steroids, antihypertensives. Last dose and plan for peri-op.
- Allergies and adverse reactions. Fasting status and last PO intake.
- Airway: dentition (loose teeth, crowns), mouth opening, neck mobility, previous difficult intubation.
🔎 Examination
- Airway: Mallampati (as above), mouth opening, neck movement, dentition.
- Cardiovascular: pulse, BP, JVP, heart sounds, peripheral perfusion if relevant.
- Respiratory: auscultation, SpO2 on room air (or current support).
- Relevant system examination depending on procedure and comorbidities.
🧪 Investigations
- As per local policy and procedure: often FBC, U&E, coag, group and save (or crossmatch). ECG if indicated (age, cardiac history, procedure).
- Echo or other cardiac workup if history suggests (e.g. IHD, heart failure, valve disease). HbA1c if diabetic. Pregnancy test if appropriate.
📞 When to Refer to Anaesthetics
- Optimisation (BP, glucose, anaemia, anticoagulation/antiplatelet timing). Cardiac or respiratory risk needing input. Difficult airway or previous problems.
- Regional vs GA discussion. Emergency surgery – discuss directly; document fasting and resuscitation status.
- Check local policy (e.g. pre-admission clinic vs ward referral). Document ASA and Mallampati when handing over.
Educational reference only. Medical disclaimer