Preoperative anaesthesia assessment and patient preparation for surgery: update and a review

Main Article Content

F J García-Miguel, MD, PhD, DESAIC S L Valencia Castillo, MD, PhD.


Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. The “Helsinki Declaration on Patient Safety in Anaesthesiology” establishes that the safety and quality of the perioperative care received by patients is the responsibility of anaesthesiologists. This declaration has been accepted by all the European Societies of Anaesthesiology and stipulates that all institutions providing perioperative anaesthesia care to patients should design protocols to guide perioperative patient management.


The present article aims to provide an evidenced-based review of preoperative assessment and preparation and to propose a protocol that can be adapted to the needs of each hospital and be incorporated into their routine practice. Emphasis is placed on the importance of correct preoperative evaluation in reducing morbidity and mortality in the surgical patient. This task can be aided by the use of preoperative questionnaires and the rational use of preoperative tests, which will also reduce unnecessary costs. Finally, the most widely accepted recommendations on preoperative fasting is discussed. The anaesthesiologist’s legal responsibility, and patients’ views in the preoperative process are also considered. A thorough clinical preoperative evaluation of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care.

Keywords: Preoperative anaesthesia assessment, patient preparation for surgery, review

Article Details

How to Cite
GARCÍA-MIGUEL, F J; VALENCIA CASTILLO, S L. Preoperative anaesthesia assessment and patient preparation for surgery: update and a review. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <>. Date accessed: 27 may 2024. doi:
Review Articles


1. American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2002; 96: 485–96. doi: 10.10 97/00000542-200202000-00037.

2. García-Miguel FJ, Serrano-Aguilar PG, López-Bastida J. Preoperative Assessment. Lancet. 2003; 362:1749-57. doi: 10.1016/s014 0-6736(03)14857-x.

3. Roizen MF. More preoperative assessment by physicians and less by laboratory tests. N Engl J Med. 2000; 342: 204–05. doi: 10.1056/ NEJM200001203420311.

4. Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014; 311:2110. doi: 10.1001/jama.2014.4573.

5. Guidelines and Protocols Advisory Committee (GPAC), Medical Services Commission, and British Columbia Medical Association. Guideline for Routine Pre-Operative Testing. Victoria BC: Ministry of Health, 2000.

6. National Institute for Clinical Excellence (2003) Guidance on the use of preoperative tests for elective surgery. NICE Clinical Guideline No 3. London: National Institute for Clinical Excellence, 2003.

7. The association of Anaesthetists of Great Britain and Ireland. Pre-operative assessment. The role of the anaesthetist. Published Accessed November 10, 2022.

8. Smetana GW. Preoperative medical evaluation of the healthy patient (Up To Date Review). Up to Date 2002; 10: N3. Published june 10, 2002. Accessed Jan 30, 2003.

9. Institute for Clinical Systems Improvement. Health Care Guideline: Preoperative evaluation. Bloomington: Institute for Clinical Systems Improvement, 2002.

10. American Association of Nurse Anesthesiology. Pre-anesthesia questionnaire. Available at: Accessed on January 31, 2022.

11. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012; 116:522. doi: 10.1097/ALN.0b013e31823c1067.

12. Barnett S, Joshi GP, Nussmeier NA. Anestesia for the older adult. (Up To Date Review). Up to Date 2022. Accessed Jun 15, 2023.

13. Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010; 210:901. doi: 10.1016/j.jamcollsurg.2010.01.028.

14. Frailty. In: Geriatrics Evaluation & Management Tools: Clinical Templates to Support Clinicians and Systems that are Caring for Older Adults, American Geriatrics Society, New York 2013.

15. Berger M, Schenning KJ, Brown CH 4th, Deiner SG, Whittintong RA, Eckenhoff RG, et al. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018; 127:140 6. doi: 10.1213/ANE.0000000000003841.

16. Hayes BD, Klein-Schwartz W, Barrueto F Jr. Polypharmacy and the geriatric patient. Clin Geriatr Med. 2007; 23:371. doi: 10.1016/j .cger.2007.01.002.

17. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014; 64:e77. doi: 10.1016/j.jacc.201 4.07.944.

18. Wijeysundera DN, Pearse RM, Shulman MA, Abbott TEF, Torres E, Ambosta A, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018; 391:2 631. doi: 10.1016/S0140-6736(18)31131-0.

19. Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999; 159:2185. doi: 10.1001/arc hinte.159.18.2185.

20. Smetana GW, Auerbach AD, Holt NF. Preoperative medical evaluation of the healthy adult patient. Up to Date 2022. Accessed May 10, 2023.

21. Yap CH, Zimmet A, Mohajeri M, Yii M. Effect of obesity on early morbidity and mortality following cardiac surgery. Heart Lung Circ. 2007; 16:31. doi: 10.1016/j.hlc.200 6.09.007.

22. Kuduvalli M, Grayson AD, Oo AY, Fabri BM, Rashid A. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2002; 22:787. doi: 10.1016/s1010-7940(02)00448-7.

23. Zacharias A, Schwann TA, Riordan CJ, Durhan SJ, Shah AS, Habib RH. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation. 2005; 112:3247. doi: 10.1161/CIRCULATIONAHA.105.553743.

24. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008; 108:812. doi: 10.1097/ALN.0b013e318 16d83e4.

25. Chung F, Subramanyam R, Liao P, E, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012; 108:768. doi: 10.1093/bja/aes022.

26. Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012; 141:436. doi: 10.1378/chest.11-0283.

27. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014; 120:268. doi: 10.1097/ ALN.0000000000000053.

28. Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009; 102:297. doi: 10.1093/bja/ aen401.

29. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011; 124:144. 10.1016/j.amjmed.2010.09.013.

30. García-Miguel FJ, García Caballero J, Gómez de Caso-Canto JA. Indications for electrocardiogram in the preoperative assessment for programmed surgery. Rev Esp Anestesiol Reanim. 2002 Jan;49(1):5-12. PMI D:11898449.

31. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130:2215. doi: 10.1161/CIR.0000000000000105.

32. Kristensen SD, Knuuti J. New ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014; 35:2344. doi: 10.1093/eurh eartj/ehu285.

33. Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LA, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009; 120:86-95. doi:10.1161/CIRCULATIONAHA.109.192575.

34. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012; 116:522-538. doi: 10.1097/ALN.0b013e31823c1067.

35. Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery, National Guideline Centre (UK). (Ed), National Institute for Health and Care Excellence (NICE), London 2016.

36. García-Miguel FJ, García Caballero J, Gómez de Caso-Canto JA. Indications for thoracic radiography in the preoperative evaluation for elective surgery. Rev Esp Anestesiol Reanim. 2002 Feb;49(2):80-8. PMID:12025252.

37. Smetana GW. The Conundrum of Unnecessary Preoperative Testing. JAMA Intern Med. 2015; 175:1359-1361. doi: 10.100 1/jamainternmed.2015.2106.

38. Macpherson DS. Preoperative laboratory testing: should any tests be "routine" before surgery? Med Clin North Am. 1993; 77:289-308. doi: 10.1016/s0025-7125(16)30252-8.

39. Osorio J, Jericó C, Miranda C, Santamaría M, Artigau E, Galofré G, et al. Improved postoperative outcomes and reduced transfusion rates after implementation of a Patient Blood Management program in gastric cancer surgery. Eur J Surg Oncol. 2021 Jun;47:1449-1457. doi: 10.1016/j.ejso.2020.11.129.

40. Bushick JB, Eisenberg JM, Kinman J, Cebul RD, Schwart JS. Pursuit of abnormal coagulation screening tests generates modest hidden preoperative costs. J Gen Intern Med. 1989; 4:493-497. doi: 10.1007/BF02599547.

41. Kaplan EB, Sheiner LB, Boeckmann AJ, Roizen MF, Beal SL, Cohen SN. et al. The usefulness of preoperative laboratory screening. JAMA. 1985; 253:3576-3581. PMI D:3999339.

42. Leung AA, McAlister FA, Finlayson SR, Bates DW. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med. 2013; 126:877-886. doi: 10.1016/j.amjmed.2013.02.039.

43. Velanovich V. The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis. Surgery. 1991; 109:236-243. PMID:2 000554.

44. Bock M, Johansson T, Fritsch G, Flamm M, Hansbauer B, Mann E, et al. The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery: a systematic review. Eur J Anaesthesiol. 2015; 32:152-159. doi: 10.1097/EJA.000000000000 0117.

45. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polaczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100:1043-1049.doi: 10.1161/01.cir.100.10.10 43.

46. Grek S, Gravenstein N, Morey TE, Rice MJ. A cost-effective screening method for preoperative hyperglycemia. Anesth Analg. 2009; 109:1622-1624. doi: 10.1213/ANE.0b0 13e3181b7c626.

47. Mathew A, Devereaux PJ, O'Hare A, Tonnelli M, Thiessen-Philbrook H, Nevis IFP, et al. Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int. 2008; 73:1069-1081. doi: 10.1038/ki.2008.29.

48. Narr BJ, Hansen TR, Warner MA. Preoperative laboratory screening in healthy Mayo patients: cost-effective elimination of tests and unchanged outcomes. Mayo Clin Proc. 1991; 66:155-159. doi: 10.1016/s0025-6196(12)60487-x.

49. Powell-Jackson P, Greenway B, Williams R. Adverse effects of exploratory laparotomy in patients with unsuspected liver disease. Br J Surg. 1982; 69:449-451. doi: 10.1002/bjs.18 00690805.

50. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008; 140:496-504. doi: 10.1111/j.1365-2141.2007. 06968.x.

51. van Veen JJ, Spahn DR, Makris M. Routine preoperative coagulation tests: an outdated practice? Br J Anaesth. 2011; 106:1-3. doi: 10.1093/bja/aeq357.

52. Sié P, Steib A. Central laboratory and point of care assessment of perioperative hemostasis. Can J Anaesth. 2006; 53:S12-20. doi: 10.1007/BF03022248.

53. Koulouvaris P, Sculco P, Finerty E, Sculco T, Sharrock NE. Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty. Clin Orthop Relat Res. 2009; 467:1859-1867. doi: 10.1007 /s11999-008-0614-8.

54. David TS, Vrahas MS. Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg. 2000; 8:66-74. doi: 10.5435/00124635-200001000-00007.

55. Lawrence VA, Kroenke K. The unproven utility of preoperative urinalysis. Clinical use. Arch Intern Med. 1988; 148:1370-1373. PMID:3377621.

56. Ollivere BJ, Ellahee N, Logan K, Miller-Jones JCA, Allen PW. Asymptomatic urinary tract colonisation predisposes to superficial wound infection in elective orthopaedic surgery. Int Orthop. 2009; 33:847-850. doi: 10.1007/s00264-008-0573-4.

57. Lamont T, Coates T, Mathew D, Scarpello J, Slater A. Checking for pregnancy before surgery: summary of a safety report from the National Patient Safety Agency. BMJ. 2010; 341:c3402. doi: 10.1136/bmj.c3402.

58. O'Neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ. 2016; 354:i3292. doi: 10.1136/bmj.i3292.

59. Anesthesia Patient Safety Foundation. Preoperative COVID testing: Examples from around the US. November 2020. Available at: Accessed on June 20, 2023.

60. American Society of Anesthesiologists, Anesthesia Patient Safety Foundation. The ASA and APSF joint statement on perioperative testing for the COVID-19 virus. June 2020. Available at: Accessed on Jun 20, 2023.

61. Szabo C, Rosenbaum S. Preoperative fasting in adults. Up to Date 2022. accessed May 10, 2023.

62. Hausel J, Nygren J, Lagerkranser M, Hellström PM. Hammarqvist F, Alsmtröm C. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg. 2001; 93:1344-1350. doi: 10.1097/00000539-200111000-00063.

63. Søreide E, Hausken T, Søreide JA, Steen PA. Gastric emptying of a light hospital breakfast. A study using real time ultrasonography. Acta Anaesthesiol Scand. 1996; 40:549-553. doi: 10.1111/j.1399-6576. 1996.tb04486.x.

64. Ouanes JP, Bicket MC, Togioka B, Garcia V, Wu CL, Murphy JD. The role of perioperative chewing gum on gastric fluid volume and gastric pH: a meta-analysis. J Clin Anest.h 2015; 27:146-152. doi: 10.1016/j.jclin ane.2014.07.005.

65. Valencia JA, Cubillos J, Romero D, Amaya W, Moreno J, Ferrer L. Chewing gum for 1 h does not change gastric volume in healthy fasting subjects. A prospective observational study. J Clin Anesth. 2019; 56:1 00-105. doi: 10.1016/j.jclinane.2019.01.021.

66. Cardoso-Júnior A, Coelho LG, Savassi-Rocha PR, Vignolo MC, Militao A, Miranda A, et al. Gastric emptying of solids and semi-solids in morbidly obese and non-obese subjects: an assessment using the 13C-octanoic acid and 13C-acetic acid breath tests. Obes Surg. 2007; 17:236-241. doi: 10.1007/s11695-007-9031-4.

67. Popivanov P, Irwin R, Walsh M, Leonard M, Tan T. Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study. Int J Obstet Anesth. 2020; 41:29-34. doi: 10.1016/j.ijoa.2019.07.010.

68. Samsom M, Vermeijden JR, Smout AJ, Van Door E, Roelofs J, Van Damm PS, et al. Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients. Diabetes Care. 2003; 26:31 16-3122. doi: 10.2337/diacare.26.11.3116.

69. Orozco-Levi M, Torres A, Ferrer M, Piera C, el-Ebiary M, de la Bellacasa JP, et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med. 1995; 152:1387-1390. doi: 10.1164/ajrc cm.152.4.7551400.

70. Kollef MH, Von Harz B, Prentice D, Shapiro SD, Silver P, John RSt, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest. 1997; 112:765-773. doi: 10.1378/chest .112.3.765.

71. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999; 2:69-78. doi: 10.1097/00075197-199901000-00012.

72. Soop M, Nygren J, Myrenfors P, Thorel A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab. 2001; 280:E576-83. doi: 10.1152/ajpe ndo.2001.280.4.E576.

73. Lidder P, Thomas S, Fleming S, Hosie K, Shaw S, Lewis S. A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery. Colorectal Dis. 2013; 15:737-745. doi: 10.111 1/codi.12130.

74. Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis. 2006; 8:563-569. doi: 10.1111/j.1463-1318.2006.00965.x.

75. Shin HJ, Koo BW, Lim D, Na HS. Ultrasound assessment of gastric volume in older adults after drinking carbohydrate-containing fluids: a prospective, nonrandomized, and noninferiority comparative study. Can J Anaesth. 2022; 69:1 160-1166. doi: 10.1007/s12630-022-02262-9.

76. Yagci G, Can MF, Ozturk E, Dag B, Ozgurtas T, Cosar A. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. Nutrition. 2008; 24:212-216. doi: 10.1016/j.nut.2007.11.003.

77. Henriksen MG, Hessov I, Dela F, Vin Hansen H, Haraslted D, Rodt SA. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand. 2003; 47:191-199. doi: 10.1034/j.1399-6576. 2003.00047.x.

78. Cho EA, Huh J, Lee SH, Ryu KH, Shim JG, Cha YB, et al. Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study. Anesth Analg. 2021; 133:690-699. doi: 10.1213/ANE. 0000000000005411.

79. Simini B, Bertolini G. Should same anaesthetist do preoperative anaesthetic visit and give subsequent anaesthetic? Questionnaire survey of anaesthetists. BMJ. 2003; 327: 79–80. doi: 10.1136/bmj.327.7406.79.

80. Simini B. Pre-operative visits by anaesthetists. Anaesthesia. 2001; 56:591. PMID: 11412179.

81. Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland. Good practice: a guide for departments of anaesthesia. 1998.

82. American Society of Anesthesiologists: The ASA Directory of Members 1994. American Society of Anesthesiologists, Park Ridge,IL, 1994.

83. Acapem J, Bouillot JL, Paquet JC, Hay JM, Coggia M. La radiographie thoracique préopératoire systématique en chirurgie générale est-elle utile? Ann Fr Anesth Rèanim. 1992; 11: 88–95. doi: 10.1016/s0750-7658(05) 80324-7.

84. García-Miguel FJ, Peyró R, Mirón-Rodríguez MF. Preoperative anesthesia assessment and patient preparation for surgery. Rev Esp Anestesiol Reanim. 2013;60( Supl 1):11-26. DOI:10.1016/S0034-9356(13)7 0006-9.