Preop Assessment — H&P, ASA & NPO

The pre-op period is the most under-appreciated part of the job for students — but it's where the case is won. The anesthesia team's job is to anticipate problems so you can avoid them (going around the hole instead of climbing out of it). A good evaluation makes sure the patient is physically and emotionally ready, and yields an anesthetic plan — plus backup plans — before induction. It's also when you build rapport and earn the patient's trust.

Work through these, anesthesia-relevant by design:

• Airway — any prior difficulty (the single best predictor); see [The Airway Exam](/playbook/airway-exam).
• OSA — screen with STOP-BANG (additive): Snoring, Tired/daytime sleepiness, Observed apnea, Pressure (HTN), BMI > 35, Age > 50, Neck > 40 cm, Gender male.
• Heart — CAD, prior CABG/stents, murmurs, HTN, exercise tolerance, aspirin/antiplatelets.
• Lungs — COPD, asthma.
• Liver / Kidney — including AKI, CKD, dialysis.
• Endocrine / Diabetes — insulin vs oral, insulin pump; chronic steroid use.
• Social — smoking, alcohol, recreational drugs.
• Medications — what they take at home and why.
• Allergies — drugs; foods (egg/soy → many propofol preparations); latex.
• Surgical/anesthesia history — family history of malignant hyperthermia, personal PONV, prior problems.
• NPO status — last solid and last liquid (what and when).

A good closing habit: "Any other health problems we haven't talked about?" — it occasionally catches something important.

Beyond the airway exam, focus on what changes your plan:

• Heart — rate/rhythm, murmurs, do heart tones and pulse match?
• Lungs — air movement, wheezes/rales.
• Peripheral pulses — especially the radial arteries (for an A-line; place it in the non-dominant hand).
• Veins — easy peripheral targets (upper extremities) for the IV.

Labs: most healthy patients for low-risk surgery need none — order based on the patient's health and the surgery. The one near-universal exception is the pregnancy test (urine, or hCG) for every woman of childbearing age. If positive, weigh urgency vs. risk and avoid midazolam/benzodiazepines and nitrous where possible.

Once the H&P is done, assign an ASA Physical Status:

NPO (nil per os) is the time from last intake to an expected empty stomach — because stomach contents can be aspirated into the lungs (pneumonia, or worse). Standard minimum fasting times:

• Patients with delayed gastric emptying need longer.
• Trauma and pain slow gastric motility — treat those patients as a full stomach regardless of timing.
• When there isn't time to wait, protect the airway with a rapid sequence induction ([RSI is covered in the Induction guide](/playbook/induction)).