1.6 History taking during Anesthetic Assessment

So, as always third time's a charm. No really, we will first start with the big three:

1. Have they ever had a surgery before or have they been under anesthesia before.
2. Next, is what medications they use regularly. (I remember this by thinking what medication the previous anesthesiologist might have used before).
3. Lastly, if they are allergic to any medications or other allergies in general.

So the flow is previous surgeries >> medications they might have used >> if the person is allergic to any medications.

Now, lets move systemetically to take the history:

The outer most is the skin so I would ask the patient if they or any of their family members ever had a high fever during a surgery. This would mean that they might have malignant hyperthermia.

This happens because under anesthesia, their muscle cells release Calcium ions. This causes massive use of ATP leading to the high body temperature and muscle rigidity.

Now, lets start from the brain (top to bottom)

1. Brain: if they have any neurological illnesses and if they are taking any medication like antiphychotics or anti-epileptics.
2. Thyroid gland: if they have a thyroid gland disorder
3. Heart: If they have hypo or hypertension, if they had an MI or cardiac arrest or any cardiac events before.
4. Lungs: if they have asthma, COPD, or other genetic diseases or if they smoke etc.
5. Stomach: if they have GERD, or if they are taking PPIs, or have other stomach conditions.
6. Liver: If they have or ever had liver disorders like Hepatitis or Jaundice etc.
7. Pancreas: if they have diabeties or any other endocrine disorder.
8. Kidneys: if they have renal disorders
9. Legs: We can ask the patient if they have any heriditary muscular disorders like myasthenia gravis. Muscle relaxants can be harmful in these patients. And we can also ask them if they can climb two flights of stairs without stopping. This would mean that their cardio vascular health is good and they are less likely to have complications.

Speaking of Physical activity, there is a scale known as NYHA scale.

I. No symptoms anytime

II. No symptoms at rest but feeling of fatigue after moderate exercise.

III. No symptoms at rest but chest pain and other symptoms after even daily life tasks.

IV Symptoms even at rest. Physical activity of any kind just exacerbates them.

Now if we sum all of this up in a scale, that would be ASA classification.