Preoperative Assessment & Risk Reduction
Match preparation to the operation, the patient and the urgency, while keeping the anaesthetic and surgical plans aligned.
Quick revision ↓ Medical Dictionary
01Assess functional reserve
Review the planned operation, urgency, previous anaesthesia, exercise tolerance, cardiopulmonary symptoms, frailty and baseline function. A comorbidity list alone does not measure physiological reserve. Ask about sleep apnoea, smoking, alcohol and practical support. New unstable symptoms may need evaluation before elective surgery, whereas emergency surgery requires balancing optimisation against the harm of delay through senior multidisciplinary judgement.
02Order selective tests
Preoperative tests should reflect the procedure and clinical findings rather than an automatic panel for everyone. Identify anaemia, renal impairment or other abnormalities that could change care and assign responsibility for acting on results. A reassuring screening ECG does not replace assessment of exertional symptoms. Communicate significant findings to anaesthesia early, particularly difficult-airway history, recent cardiac events or a major change in function.
03Plan medicines and fasting
Reconcile prescribed, non-prescribed and herbal products. Anticoagulants, antiplatelets, diabetes medicines and long-term steroids need an individual perioperative plan. Do not stop every antithrombotic automatically or continue every medicine by habit. Fasting instructions follow the anaesthetic pathway and patient risk; unnecessary prolonged fasting can worsen dehydration. Confirm the patient understands which medicines to take and when to seek clarification.
04Prevent avoidable complications
Assess thrombosis and bleeding risks together and select mechanical or pharmacological prophylaxis when appropriate. Screen nutritional problems and optimise anaemia when time permits. Infection prevention, temperature control, pressure-area care and glucose management are shared team responsibilities. Prophylactic antibiotics need the correct indication and timing; continuing them indefinitely is not a substitute for clean technique or postoperative assessment.
05Agree a recovery plan
Enhanced recovery combines preparation, anaesthetic care, analgesia, mobilisation and nutrition with measurable goals. Discuss possible critical-care needs and treatment preferences before the operation when feasible. Confirm site, procedure, consent, allergies and equipment using the safety checklist. A checklist is a spoken team check that can expose discrepancies, not a form completed silently after the patient leaves theatre.
High-Yield Revision
- Optimisation must be balanced against the urgency of surgery.
- Medicine changes need an explicit patient-specific plan.
- Enhanced recovery spans the entire perioperative pathway.
Common Pitfalls
- Do not use blanket fasting or anticoagulant instructions without review.
- Do not treat a completed checklist as proof that discrepancies were resolved.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.