The safe conduct of anaesthesia requires meticulous preoperative assessment, preparation and planning. In the case of elective procedures this should occur well in advance of surgery, allowing a comprehensive review of concurrent disease, medication and social issues. This is often carried out in a dedicated preoperative assessment clinic by a multidisciplinary team comprising nursing and medical staff as well as pharmacists and specialist technicians.

Whilst patients undergoing emergency surgery may not benefit from such a structured approach to their preoperative management, they must nevertheless undergo rigorous systematic review and preparation to ensure optimum care.

Preoperative assessment

Screening

When elective surgery is first planned, a screening questionnaire may be used to provide information regarding comorbidity that may require early preoperative review or intervention. A need for additional specialist input can be identified and acted upon at this stage.

Preoperative assessment clinic

During subsequent preoperative assessment a general medical history is taken, detailing concurrent disease and its management.

• Correspondence in the clinical notes may provide a useful outline of a disease process, giving some indication of its stability, as well as information on previous hospital admissions, current medication and recent investigation results.

• A history should be taken of previous anaesthetic experience. A family history of problems associated with anaesthesia must be noted and may require further investigation.

• The patient's general health should be assessed. In particular a history of reflux should be noted, along with smoking and alcohol habits.

• A history of recreational drug use may be appropriate.

• A list of current medication, including dosage and recent changes, is essential, along with a history of any allergic or other adverse drug reactions. The nature of the allergy or reaction should be recorded.

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