| History and examination |
- Review of past anesthesia-related events and postoperative complications
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- Assess for:
- Cardiac insufficiency and arrhythmias. Ensure optimization prior to elective surgery.
- Respiratory insufficiency. Ensure optimization prior to elective surgery.
- Potential difficult airway.
- Bulbar palsy, reflux, and aspiration risk.
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- Review of weight, nutritional deficiencies, and pressure areas
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- Review of current medications, in particular long-term steroids
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| Investigations and laboratory assessment |
- Full blood examination (in particular baseline hemoglobin)
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- Electrolytes (in particular baseline serum potassium)
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- Echocardiogram (within 12 months or if there is a change in symptoms)
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- Respiratory function testing (including forced vital capacity):
- FVC <50% predicted are at increased risk of complications
- FVC <30% predicted are at high risk of complications
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- Clinical polysomnograph if suspected OSA
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| Other considerations |
- Patients with metabolic myopathy need a fasting plan specific to their metabolic needs. Discussion with the metabolic physician is essential.
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- Discussion of risk:
- Specific anaesthesia risk
- Mortality
- Prolonged ventilation, failure to extubate
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- Discussion of advanced directives, if appropriate.
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- Allied health referral (eg, physiotherapy).
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- Preoperative training for noninvasive ventilatory support.
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