*Extracted from comprehensive anesthesia notes.*
Preparatory Mindset
Focus on: physiologic effects of anesthesia, drug mechanisms, airway management, and complication recognition. Exam questions often test classification systems (ASA, airway assessment) and complication management.
Core Concepts
1. Core Goals
- - Reduce perioperative morbidity and mortality
- - Alleviate patient anxiety
- - Establish doctor-patient relationship
- - Identify risks & optimize condition
History
- - General condition: medical history, medications, allergies
- - Anesthetic history: prior complications, drug responses
- - Family history: adverse anesthesia events (e.g., malignant hyperthermia)
- - Social history: smoking, alcohol, drugs
- - System review: heart, lung, diabetes, hypertension, GERD
- - Vital signs: BP, HR, SpO₂, height, weight
- - Airway assessment: mouth opening, thyromental distance, neck movement, teeth
- - Head and neck, Lungs, heart, abdomen, extremities, neurologic status
- - Hematology: Hb/Hct, coagulation
- - Biochemistry: electrolytes, renal/hepatic function
- - ECG: men >45, women >55
- - Chest X-ray: smokers, elderly, cardiopulmonary disease
Key Point: 3. ASA Physical Status CLASSIFICATION ()
- - ASA I: Normal healthy patient
- - ASA II: Mild systemic disease (no limitation)
- - ASA III: Severe systemic disease (functional limitation)
- - ASA IV: Severe disease → constant threat to life
- - ASA V: Moribund; not survive without surgery
- - ASA VI: Brain-dead organ donor
- - E: Emergency surgery
Key Point: 4. Preoperative Fasting (ASA Guidelines) ()
- - Clear liquids: 2 h
- - Breast milk: 4 h
- - Infant formula / non-human milk / light meal: 6 h
- - Fried/fatty/heavy meal: 8 h or longer
- - Purpose: reduce pulmonary aspiration risk
- - Continue: antihypertensives, antiarrhythmics, bronchodilators
- - Hold: anticoagulants (per protocol)
- - Drugs: sedatives (midazolam), analgesics, antiemetics, anticholinergics
- - Control: HTN (<180/100 mmHg), hyperglycemia, asthma
- - 6. Indications to Delay Surgery
- - MI within 6 months
- - Unstable arrhythmias
- - Severe coagulopathy
- - Uncontrolled hypoxia/hypertension
- - Severe organ dysfunction
High-Yield Points
- ASA classification is a must-know for exam
- Understand differences between general vs regional anesthesia
- Complications and their management are frequently tested
- Know the Mallampati score and airway assessment criteria