Patient History and Physical Examination

The preoperative history and physical examination are the foundation of anesthetic assessment. The history elicits comorbidities, prior anesthetic experiences, medications, allergies, and functional capacity, while the examination focuses on findings that bear on anesthetic risk, including a structured airway assessment and cardiopulmonary review. Together they direct any further investigation and feed the risk-stratification tools used in perioperative planning.

Definition

Preoperative history and physical examination is the structured clinical interview and bedside assessment performed before anesthesia to identify comorbidities, medications, allergies, prior anesthetic problems, functional capacity, and physical findings relevant to anesthetic and surgical risk.

Scope

This topic covers the structure and content of the preoperative history and examination as a methodological reference: the elements that are routinely sought, the airway and cardiopulmonary focus of the examination, and how findings link to functional capacity and downstream risk indices. It does not provide individual diagnostic thresholds or management instructions.

Core questions

• What comorbidities, medications, and prior anesthetic events are present?
• What is the patient's functional capacity?
• Does the airway examination suggest difficulty?
• Which findings warrant further investigation before surgery?

Key concepts

• Systematic history taking
• Prior anesthetic and family anesthetic history
• Medication and allergy review
• Functional capacity
• Airway assessment
• Cardiopulmonary examination
• Targeted (selective) investigation

Mechanisms

The history and examination act as the screening layer of preoperative assessment. By eliciting comorbidities and functional limitations and identifying abnormal physical findings, they determine which patients need additional testing and which risk indices apply. Guidelines emphasize that functional capacity and clinical findings, rather than routine investigations, drive subsequent evaluation, so the interview and examination directly shape cardiac and pulmonary risk estimation (Fleisher, 2014; Smetana, 2006). The airway examination, in particular, gathers anatomical predictors used to anticipate difficulty with airway management.

Clinical relevance

A focused history and examination orient the entire perioperative plan and are the input to validated risk tools. As reference material this topic explains what is assessed and why; it characterizes the evaluation process and is not a substitute for individualized clinical judgement or management.

History

Preoperative clinical evaluation predates modern investigations, and its content was progressively codified as anesthesia developed; later, evidence syntheses and guidelines clarified which historical and examination findings most strongly predict perioperative outcomes, anchoring the cardiac and pulmonary risk literature (Lee, 1999; Smetana, 2006; Fleisher, 2014).

Debates

How much routine preoperative testing should follow the history and examination?

A recurring methodological question is how far to rely on the history and examination versus routine investigations; evidence syntheses and guidelines favor selective, finding-directed testing rather than indiscriminate panels.

Key figures

• Lee A. Fleisher
• Gerald W. Smetana
• Thomas H. Lee

Seminal works

• fleisher-2014
• smetana-2006

Frequently asked questions

Why is functional capacity assessed in the preoperative history?

Functional capacity summarizes how much physiological reserve a patient has and is used by perioperative guidelines to decide whether further cardiac evaluation is warranted before surgery.

What does the preoperative airway examination look for?

It gathers anatomical features used to anticipate possible difficulty with airway management, so that the anesthetic plan can prepare for it; this entry describes the purpose of the assessment rather than giving management steps.