While a physical exam and medical tests provide valuable information, patients should be encouraged to describe their symptoms and habits. Proper pre-operative evaluation can reduce risk of surgical complications, cut the length of hospital stay and reduce chances of postponed or cancelled surgery. Questions should relate to the following:
- Past Medical History: The patient should be evaluated about significant past and present diseases/illnesses, surgery, including complications and trauma. Know if the patient had a bad reaction to anesthesia will allow the anesthetist to take steps to prevent this from recurring, notes an article in Outpatient Surgery Magazine (April 2019 issue). This should be done several weeks before the planned surgery.
- Medications and Supplements: Certain medications and supplements can affect anesthesia, pain management, and healing. Blood thinners such as aspirin or warfarin increase bleeding risks. The risk of bleeding varies depending on the procedure and patients scheduled for surgery need to be advised on whether they should be continued or temporarily stopped. Likewise, some classes of antidepressants can reduce the efficacy of opioids, leading to less effective pain management. By asking questions about medication intake, physicians can consider alternative strategies.
- Immunization Status: When the patient is a child, immunization history should be taken before surgery. Anesthesia or surgery may affect the immune response of the vaccine. As most surgeries are planned, vaccinations can be scheduled accordingly. In cases of emergency surgery, vaccination status should not delay treatment.
- Smoking: Physicians need to know about the patient’s smoking habits. Compared to nonsmokers, people who smoke have a higher risk of serious complications after surgery. Smoking damages your heart and lungs and can lead to breathing problems. Smoking can also cause wound infections and delay healing. To promote successful surgical outcomes, physicians recommend quitting at least a month before the operation and not smoking for several weeks afterward, or not at all.
- Marijuana: Marijuana has a sedative effect and can complicate surgery. Similar to cigarettes, marijuana can negatively impact anesthesia. Physicians need to know if the patient uses. While discussing surgery anesthesia and marijuana, patients should be instructed to avoid all types of marijuana—smoking marijuana, edibles, and synthetic marijuana. Marijuana smokers have a higher risk of developing pneumonia after surgery and greater incision scarring.
- Sleep Apnea: Anesthesiologists need to evaluate patients for sleep apnea, the condition that causes chronic snoring and interrupted breathing during sleep. Since anesthesia slows down breathing, sleep apnea increases risk of side effects. Patients with sleep anesthesia may face difficulty in regaining consciousness after surgery.
- Stroke: Anesthesiologists should therefore ask patients if they or a family member has ever had a stroke or experienced heat stroke, because this increases their risk of malignant hyperthermia, a severe reaction which can cause muscle rigidity. According to recent research published in J Neuroanaesthesiol Crit Care, patients who have suffered a stroke may have neurological disabilities and related complications, which can make perioperative management difficult.