Elements of the Preoperative Physical Examination

Elements of the Preoperative Physical Examination

The preoperative history and physical examination complement one another: The physical examina-tion may detect abnormalities not apparent from the history, and the history helps focus the physical examination. Examination of healthy asymptomatic patients should include measurement of vital signs (blood pressure, heart rate, respiratory rate, and temperature) and examination of the airway, heart, lungs, and musculoskeletal system using standard techniques of inspection, auscultation, palpation, and percussion. Before procedures such as a nerve block, regional anesthesia, or invasive monitoring the relevant anatomy should be examined; evidence of infection near the site or of anatomic abnormali-ties may contraindicate the planned procedure. An abbreviated neurological examination is important when regional anesthesia will likely be used. The preoperative neurological examination serves to document whether any neu-rological deficits may be present before the block is performed.

The anesthesiologist must examine the patient’s airway before every anesthetic procedure. The patient’s dentition should be inspected for loose or chipped teeth, caps, bridges, or dentures. Poor fit of the anesthesia mask should be expected in edentu-lous patients and those with significant facial abnor-malities. Micrognathia (a short distance between the chin and the hyoid bone), prominent upper incisors, a large tongue, limited range of motion of the tem-poromandibular joint or cervical spine, or a short or thick neck suggest that difficulty may be encoun-tered in direct laryngoscopy for tracheal intubation .