Preoperative assessment

In this chapter, we discuss the major principles of preoperative anesthetic assessment in patients undergoing neurosurgical procedures due to their importance in ensuring a favorable outcome. The focus of the patient's medical history, the physical examinations and tests required, instructions on preanesthetic medication, and policies on preoperative fasting are described. Neurosurgical procedures should ideally be preceded by a comprehensive neurological assessment. This should include a general neurological evaluation such as according to the Glasgow Coma Scale. The reaction of the pupils and motor and sensory function should also be assessed. If there is evidence of elevated intracranial pressure, the appropriate evaluation should be made. Focal neurological assessment can help identify neurological deficits and other abnormalities of the related nerve systems. Determining the patient's history of and predisposition to seizures may also be helpful. Imaging, such as by computed tomography or magnetic resonance imaging, can provide additional information regarding pathological lesions and other visible morphological abnormalities of the brain. In cases involving emergency surgery, a complete preoperative evaluation may not be possible. Nonetheless, the anesthesiologist should still attempt to perform the most critical evaluations in such patients. These evaluations involve multiple assessments performed with the aim of anticipating intraoperative or postoperative complications. Many problems can be anticipated and avoided with adequate preoperative assessment and planning.