Pre and Post-Operative Considerations with Questions and verified Answers
1. What are the key components of preoperative assessment?
Answer: Medical history, physical examination, functional status assessment,
laboratory studies, imaging studies, cardiac risk assessment, pulmonary function
evaluation, and anesthesia consultation.
2. What is the ASA Physical Status Classification System?
Answer: ASA I: Normal healthy patient, ASA II: Mild systemic disease, ASA III:
Severe systemic disease, ASA IV: Severe disease that is constant threat to life, ASA
V: Moribund patient, ASA VI: Brain-dead organ donor.
3. What laboratory tests are routinely ordered preoperatively?
Answer: Complete blood count, comprehensive metabolic panel, coagulation
studies (PT/PTT/INR), type and screen/crossmatch, urinalysis. Additional tests
based on patient factors and procedure complexity.
4. When is preoperative cardiac evaluation indicated?
Answer: Based on revised cardiac risk index (RCRI) factors: high-risk surgery,
ischemic heart disease, congestive heart failure, cerebrovascular disease, diabetes
requiring insulin, and creatinine >2.0 mg/dL.
5. What is the Revised Cardiac Risk Index (RCRI)?
Answer: Risk stratification tool using 6 factors to predict perioperative cardiac
complications. 0 factors: 0.4% risk, 1 factor: 0.9% risk, 2 factors: 6.6% risk, ≥3
factors: ≥11% risk.
6. What pulmonary function tests are indicated preoperatively?
Answer: Spirometry for patients with unexplained dyspnea, COPD exacerbation,
or thoracic/upper abdominal surgery with respiratory risk factors. Arterial blood
gas if severe pulmonary disease.
7. How is perioperative bleeding risk assessed?
,Answer: History of bleeding disorders, family history, medication review
(anticoagulants, antiplatelets), laboratory studies (PT/PTT/INR, platelet count), and
consideration of procedure-specific bleeding risk.
8. What is the Caprini Risk Assessment Model?
Answer: Tool for venous thromboembolism (VTE) risk stratification using patient
factors (age, BMI, mobility, medical history). Scores 0-2: low risk, 3-4: moderate
risk, ≥5: high risk.
9. When should surgery be delayed for optimization?
Answer: Uncontrolled diabetes (HbA1c >8%), acute cardiac events, severe anemia
(Hb <7-8 g/dL), active infection, severe malnutrition, or uncontrolled medical
conditions.
10. What is the role of preoperative consultation?
Answer: Cardiology for cardiac risk assessment, pulmonology for severe
respiratory disease, endocrinology for diabetes management, hematology for
bleeding disorders, and anesthesiology for all patients.
11. How is functional status assessed preoperatively?
Answer: Activities of daily living, exercise tolerance, metabolic equivalents (METs),
6-minute walk test, and validated tools like the Duke Activity Status Index.
12. What imaging studies are typically required preoperatively?
Answer: Chest X-ray for thoracic surgery or patients >50 years with
cardiopulmonary disease. ECG for patients >40 years or with cardiac risk factors.
Additional imaging based on surgical indication.
Preoperative Optimization
13. How should diabetes be managed preoperatively?
, Answer: Target HbA1c <7-8%, adjust insulin regimens on surgery day, monitor
blood glucose closely, continue long-acting insulin, hold short-acting insulin on
NPO days, and consider insulin infusion for major surgery.
14. What is the recommended approach to preoperative smoking cessation?
Answer: Cessation >8 weeks preoperatively reduces pulmonary complications.
Even 12-24 hours cessation improves oxygen delivery. Nicotine replacement
therapy and counseling should be offered.
15. How should anemia be managed preoperatively?
Answer: Identify and treat underlying cause, iron supplementation for iron
deficiency, consider erythropoietin for chronic kidney disease, and blood
transfusion if Hb <7-8 g/dL depending on cardiac status.
16. What nutritional optimization is recommended preoperatively?
Answer: Screen for malnutrition using validated tools, provide nutritional
counseling, consider preoperative nutrition support for severely malnourished
patients (albumin <3.0 g/dL, weight loss >10%).
17. How should obesity be addressed preoperatively?
Answer: BMI >40 increases surgical risk. Consider weight loss if time permits,
optimize comorbidities (diabetes, sleep apnea, hypertension), and plan for
appropriate equipment and positioning.
18. What is prehabilitation and its benefits?
Answer: Multimodal preoperative optimization including exercise training,
nutritional support, and psychological preparation. Improves functional capacity,
reduces complications, and accelerates recovery.
19. How should sleep apnea be managed preoperatively?
Answer: Continue CPAP therapy perioperatively, optimize positioning, consider
regional anesthesia when possible, and monitor closely in PACU. Untreated sleep
apnea increases perioperative complications.
1. What are the key components of preoperative assessment?
Answer: Medical history, physical examination, functional status assessment,
laboratory studies, imaging studies, cardiac risk assessment, pulmonary function
evaluation, and anesthesia consultation.
2. What is the ASA Physical Status Classification System?
Answer: ASA I: Normal healthy patient, ASA II: Mild systemic disease, ASA III:
Severe systemic disease, ASA IV: Severe disease that is constant threat to life, ASA
V: Moribund patient, ASA VI: Brain-dead organ donor.
3. What laboratory tests are routinely ordered preoperatively?
Answer: Complete blood count, comprehensive metabolic panel, coagulation
studies (PT/PTT/INR), type and screen/crossmatch, urinalysis. Additional tests
based on patient factors and procedure complexity.
4. When is preoperative cardiac evaluation indicated?
Answer: Based on revised cardiac risk index (RCRI) factors: high-risk surgery,
ischemic heart disease, congestive heart failure, cerebrovascular disease, diabetes
requiring insulin, and creatinine >2.0 mg/dL.
5. What is the Revised Cardiac Risk Index (RCRI)?
Answer: Risk stratification tool using 6 factors to predict perioperative cardiac
complications. 0 factors: 0.4% risk, 1 factor: 0.9% risk, 2 factors: 6.6% risk, ≥3
factors: ≥11% risk.
6. What pulmonary function tests are indicated preoperatively?
Answer: Spirometry for patients with unexplained dyspnea, COPD exacerbation,
or thoracic/upper abdominal surgery with respiratory risk factors. Arterial blood
gas if severe pulmonary disease.
7. How is perioperative bleeding risk assessed?
,Answer: History of bleeding disorders, family history, medication review
(anticoagulants, antiplatelets), laboratory studies (PT/PTT/INR, platelet count), and
consideration of procedure-specific bleeding risk.
8. What is the Caprini Risk Assessment Model?
Answer: Tool for venous thromboembolism (VTE) risk stratification using patient
factors (age, BMI, mobility, medical history). Scores 0-2: low risk, 3-4: moderate
risk, ≥5: high risk.
9. When should surgery be delayed for optimization?
Answer: Uncontrolled diabetes (HbA1c >8%), acute cardiac events, severe anemia
(Hb <7-8 g/dL), active infection, severe malnutrition, or uncontrolled medical
conditions.
10. What is the role of preoperative consultation?
Answer: Cardiology for cardiac risk assessment, pulmonology for severe
respiratory disease, endocrinology for diabetes management, hematology for
bleeding disorders, and anesthesiology for all patients.
11. How is functional status assessed preoperatively?
Answer: Activities of daily living, exercise tolerance, metabolic equivalents (METs),
6-minute walk test, and validated tools like the Duke Activity Status Index.
12. What imaging studies are typically required preoperatively?
Answer: Chest X-ray for thoracic surgery or patients >50 years with
cardiopulmonary disease. ECG for patients >40 years or with cardiac risk factors.
Additional imaging based on surgical indication.
Preoperative Optimization
13. How should diabetes be managed preoperatively?
, Answer: Target HbA1c <7-8%, adjust insulin regimens on surgery day, monitor
blood glucose closely, continue long-acting insulin, hold short-acting insulin on
NPO days, and consider insulin infusion for major surgery.
14. What is the recommended approach to preoperative smoking cessation?
Answer: Cessation >8 weeks preoperatively reduces pulmonary complications.
Even 12-24 hours cessation improves oxygen delivery. Nicotine replacement
therapy and counseling should be offered.
15. How should anemia be managed preoperatively?
Answer: Identify and treat underlying cause, iron supplementation for iron
deficiency, consider erythropoietin for chronic kidney disease, and blood
transfusion if Hb <7-8 g/dL depending on cardiac status.
16. What nutritional optimization is recommended preoperatively?
Answer: Screen for malnutrition using validated tools, provide nutritional
counseling, consider preoperative nutrition support for severely malnourished
patients (albumin <3.0 g/dL, weight loss >10%).
17. How should obesity be addressed preoperatively?
Answer: BMI >40 increases surgical risk. Consider weight loss if time permits,
optimize comorbidities (diabetes, sleep apnea, hypertension), and plan for
appropriate equipment and positioning.
18. What is prehabilitation and its benefits?
Answer: Multimodal preoperative optimization including exercise training,
nutritional support, and psychological preparation. Improves functional capacity,
reduces complications, and accelerates recovery.
19. How should sleep apnea be managed preoperatively?
Answer: Continue CPAP therapy perioperatively, optimize positioning, consider
regional anesthesia when possible, and monitor closely in PACU. Untreated sleep
apnea increases perioperative complications.
