The pre-anesthesia physical exam is one component of a larger preoperative evaluation that takes place to reduce a patient’s level of surgical risk and optimize outcomes. Preoperative evaluations help reduce the amount of time patients spend in the hospital and lower medical costs (2). Furthermore, evaluating a patient’s cardiac, pulmonary, and respiratory health significantly lowers the risk of complications due to anesthesia (2). As a basic element of anesthetic care, a primary care doctor, anesthesiologist, and other medical specialists on the patient’s care team may all be involved with aspects of the pre-anesthesia physical exam and broader preoperative medical evaluation. 

Preoperative risk is determined by multiple factors, including the patient’s health status, the level of risk of the particular procedure, and the type of anesthetic drugs that are used (5). Patient-related factors that affect preoperative risk include cardiovascular health, pulmonary health, nutrition status, respiratory health, alcohol and tobacco use, and any medications that a patient is taking. Patients undergo a medical history review, a physical examination, and relevant medical tests during the preoperative assessment to minimize the level of risk as much as possible. 

Morbidity and mortality during surgical procedures are usually due to cardiac, respiratory, or infectious causes (2). In terms of anesthesia, the greatest risk is airway problems and failures to provide adequate ventilation (4). In order to ensure the highest level of patient safety, the pre-anesthesia physical exam should go hand-in-hand with the medical history evaluation and take place several weeks before the procedure is scheduled (2). At a minimum, the physical exam should thoroughly assess the heart, lungs, and airway and record the patient’s vital signs (5). Additional evaluation may be necessary for patients with more risk factors, especially patients with a history of cardiopulmonary complications (4). 

During the pre-anesthesia physical exam, the provider will take note of the patient’s heart rate and heart rhythm and listen to the heart for the presence of any murmurs (1). Baseline heart rate and blood pressure should be recorded as an aspect of overall cardiovascular health (1). Providers will also look for any factors that predict difficulties with airway management, such as difficulty visualizing a portion of the airway or anatomic features or abnormalities in the airway (1). Additionally, providers will listen for lung sounds that may indicate difficulties with oxygenation during the procedure. Considering that ventilation problems are one of the most common complications during anesthesia, assessing the baseline respiratory rate and oxygen saturation of the patient is also routine (1). 

Older patients and patients with preexisting conditions will likely require a more thorough evaluation and additional tests. For example, a cognitive evaluation for delirium, dementia, and depression is recommended for patients over 65, as these conditions are linked to an increased risk of morbidity and mortality (3). Nutritional status is another consideration for patients of all ages since malnourished patients also have higher surgical and anesthesia-related risk (2). However, current medical guidelines do not recommend unnecessary preoperative testing for patients who are low-risk, as unnecessary testing can waste limited healthcare resources and result in delays of necessary medical procedures (4). 

References 

1. Alshaeri, Taghreed and Marianne D. David. “Physical Examination and Airway Evaluation.” Anesthesiology Core Review: Part One Basic Exam Eds. Brian S. Freeman, and Jeffrey S. Berger. McGraw Hill, 2014, https://accessanesthesiology.mhmedical.com/content.aspx?bookid=974&sectionid=61588180. 
2. King, M S. “Preoperative evaluation.” American family physician vol. 62,2 (2000): 387-96. 
3. Kumar, Chandrika et al. “Preoperative Assessment in Older Adults: A Comprehensive Approach.” American family physician vol. 98,4 (2018): 214-220. 
4. O’Donnell, Frederick T. “Preoperative Evaluation of the Surgical Patient.” Missouri medicine vol. 113,3 (2016): 196-201. 
5. Zambouri, A. “Preoperative evaluation and preparation for anesthesia and surgery.” Hippokratia vol. 11,1 (2007): 13-21.