Special Issues in Preoperative Evaluation

A known history or suggestive history (e.g., hyperthermia or rigidity during anesthesia) of malignant hyperthermia in a patient or family member must be clearly documented in the preoperative assessment.
The team must be informed so that the MH protocol is ready.
Patients are asymptomatic until they are exposed to triggering agents (volatile anesthetics & succinylcholine).
Certain neuromuscular diseases are associated with elevated risks of MH, including some muscular dystrophies (i.e., Duchenne, Becker, myotonic).

Increases risks for a range of postoperative complications, including mortality, cardiac complications, pulmonary complications, acute stroke, and surgical site infections.
A child is considered a passive smoker if anyone at home is smoking, increasing respiratory complications.

Geriatric-specific risk factors such as functional and cognitive impairment are associated with poor postoperative outcomes.

History of prematurity, low birth weight, and neonatal intensive care admission.
Gestational age (GA) less than 37 weeks is a premature infant and at high risk for respiratory complications (RDS) and other organ dysfunction.
Post-general anesthesia apnea until age of 60 weeks post-conceptional age (GA + age after birth).
May present with syndromes or congenital anomalies.
Children less than 2 years old have a high vagotonic effect over the sympathetic system, making them heart rate and cardiac output dependent; thus, bradycardia is a risk.

Identify any secondary causes of hypertension, presence of other cardiovascular risk factors (e.g., smoking, diabetes mellitus), and evidence of end-organ damage (ECG, creatinine concentration).
The risk of cardiovascular complications is generally not evident for systolic blood pressure values less than 180 mm Hg or diastolic blood pressure values less than 110 mm Hg.
Long-term antihypertensive treatment should be continued up to the day of surgery, with possible exceptions for ACE inhibitors and ARBs, which if given within 24 hours before surgery are consistently associated with increased risks of intraoperative hypotension.

Risk of intraoperative bleeding; contraindication for neuraxial block.
Antiplatelet agents: Must be held for 7-10 days, except for mini aspirin which is safe.
Antithrombotic agents:
- Heparin (LMWH): at least 12-24 hours hold.
- Unfractionated heparin: 2-4 hours hold and check coagulation status.
- Warfarin: 4-5 days hold and INR must be normal.

The ASA Classification is a physical status classification used to determine a patient’s risk with anesthesia.

Classification	Description
ASA 1	Healthy patients
ASA 2	Mild to moderate systemic disease caused by the surgical condition or by other pathological processes, and medically well controlled
ASA 3	Severe disease process which limits activity but is not incapacitating
ASA 4	Severe incapacitating disease process that is a constant threat to life
ASA 5	Moribund patient not expected to survive 24 hours with or without an operation
ASA 6	Declared brain-dead patient whose organs are being removed for donor purposes

🩺 MedAtlax