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Anesthetic history and examination
Ideally, the anesthetist should take a full history and examine each patient, but for the reasons already identified this is seldom possible. This section concentrates on features of particular relevance to the anesthetist.
PREVIOUS ANESTHETICS AND OPETATIONS These may have occurred in hospitals or dental surgeries. Inquire about inherited or ‘family’ diseases (e.g. sickle-cell disease, porphyria) and difficulties with previous anesthetics (e.g. nausea, vomiting, dreams, awareness, postoperative jaundice). Check the records of previous anesthetics to rule out or clarify problems such as difficulties with intubation, allergy to drugs administered, or adverse reactions (e.g. malignant hyperpyrexia, see below). The approximate date of previous anesthetics, particular if recent, should be identified to avoid the risk of repeat exposure to halothane (see page 59). Details of previous surgery may reveal potential anesthetic problems, for example cardiac or pulmonary surgery. PRESENT AND PAST MEDICAL HISTORY Of all the aspects of the patient’s medical history, those relating to the cardiovascular and respiratory systems are the most important. The questions and detail required will vary depending upon the disease present, its severity, anticipated anesthesia the planned operation.
Cardiovascular system
Specific inquiries must be made about:
Patients with a proven history of myocardial infarction are at a greater risk of perioperative reinfarction, the incidence of which is related to the time interval between infarct and surgery. Elective surgery should be postponed until at least 6 months after the event. Untreated or poorly controlled hypertension (diastolic consistently >110 mmHg ) may lead to exaggerated cardiovascular responses during anesthesia. Both hypertension and hypotension can be precipitated which increase the risk of myocardial ischaemia. Heart failure will be worsened by the depressant effects of anesthetic drugs on the heart, thereby impairing the perfusion valves may be on anticoagulants. These may need to be stopped or changed prior to surgery. Antibiotic prophylaxis will be required during certain types of surgery.
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