Adult elective surgery preoperative assessment indications to examine

Pre operative assessment - Indications to examine

• Major surgery
  Duration over one hour e.g AAA repair, hysterectomy, posterior repair, major colorectal surgery, open cholecystectomy, major vascular surgery, pelvic malignancy, arthroplasty patients, nephrectomy, TURP/BT and fundoplication
• Patient over the age of 70–75 (depending on co-morbidities)
• Poor exercise tolerance (less than 1 flight stairs) due to cardiac or respiratory issues
• Cardiac symptoms/known cardiac disease: IHD/angina, peripheral oedema, orthopnoea, murmur, blackouts, not stress related palpations.
• Respiratory symptoms/disease: COPD, emphysema, pulmonary fibrosis, not stable asthmatics.
  Productive cough, unexplained breathlessness, smokers with clinical signs e.g. cough or sputum.
• ASA 3 or 4
• Hypertension with LVH on ECG

The purpose of examination is to find undiagnosed valvular defects e.g. aortic stenosis and HOCM.
Respiratory examination could change the method of anaesthetic that is given depending on the findings.