• Establish relationship
  
• Familiarize self with patient, their medical problems and need for further evaluation, and the planned surgical procedure
  
• Assess anesthetic risk and develop perioperative plan (preoperative medications, intraoperative management, postoperative care)
  
• Discuss pertinent anesthetic risks, answer questions, and obtain informed consent
  
• Document the above

Should be done as early as possible before the day of surgery for high-risk patients.

Institutional differences in requirements and role of preoperative anesthesia evaluation clinics.

• Past medical history:
  
  
  
  • Disease processes, symptoms, treatment, severity
    
  • Degree of optimization
    
  • Need for further consultation/testing
    
  • ASA classification correlates well with outcomes
  
  
• Past surgical history
  
• Past anesthetic history: general, MAC, spinal, epidural, peripheral nerve blocks
  
• Past history of anesthetic complications: allergic reactions, severe postoperative nausea and vomiting, delayed awakening, prolonged paralysis, neuropathy, intraoperative awareness, hoarseness, difficult intubation, postdural puncture headache
  
• Family history of anesthetic complications: malignant hyperthermia, prolonged paralysis
  
• Current medications:
  
  
  
  • Updated list and what patient took/to take day of surgery
    
  • Implications regarding intraoperative hemodynamics, drug interactions, tolerance to anesthetic drugs, bleeding tendencies, electrolyte abnormalities
    
  • See below for role of beta-blockers
    
  • Herbs or supplements, while not considered medications, can have significant side effects or drug interactions and the patient must be asked about their use (see Chapter 10)
  
  
• Allergies:
  
  
  
  • Allergy versus adverse effects
    
  • Medications, latex (associated risk factors: see Chapter 35), adhesives, egg, soy