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Preoperative Physical Exam

doctor

The General Physical Examination and the Systemic Examination are both essential components of your preoperative assessment.

Major surgery, such as a hip replacement, puts a lot of demands on your body and your surgeon and anaesthetist will want to be sure you are strong enough to cope with it.

Should any potential problems be found (or even suspected) during the examinations then further tests will be arranged.

General Physical Examination

This focuses on vital signs: -

  • Temperature
  • Blood pressure
  • Respiratory Rate
  • Pulse
  • BMI (Body Mass Index)

The general physical exam draws attention to any possible problems. If found these will be addressed during the systemic examination and, if necessary, further investigations will be arranged.

Systemic Examination

This is a more detailed examination and covers each of the major physical systems along with your airways.

CVS - cardio vascular system

Taking Blood Pressure

The first step is measuring blood pressure (BP) and pulse rate. Hypertension (elevated BP) needs to be controlled prior to surgery as it will result in increased blood loss during the operation and there is an increased risk of a cardiovascular or cerebrovascular accident (a heart attack or stroke)

An irregular pulse shows arrhythmia or atrial fibrillation which must be dealt with before the operation.

Further tests may need to be carried out to check for angina, heart failure, infarction or valvular disease.

Respiratory system

You will be checked for any abnormal breath sounds such as: -

Crackles or crepitations - which show water is present in the lungs (various causes including heart failure)

Wheeze - which is associated with asthma and COPD (chronic obstructive pulmonary disease).

Decreased breath sounds - which show accumulation of water in the pleural space (pleural effusion).

Asthma and infections of the respiratory tract should be dealt with pre-operatively.

If the respiratory tract is clear then optimum oxygen saturation and blood gas tensions can be maintained.

Gastrointestinal tract

When a patient is anesthetised there is high risk of pulmonary aspiration of regurgitated gastric contents which can result in acid pneumonitis (chemical inflammation of lungs), severe bronchospasm, pneumonia and death. In order to reduce this risk the surgeon will check, and deal with, any bowel obstructions.

Musculoskeletal

skeleton

You will be checked for any skeletal malformations such as kyphoscoliosis (curvature of the spine).

Skeletel disorders, especially those related to the trunk and chest areas, may result in respiratory difficulties during surgery.

Some muscular disorders like myathenia gravis may result in respiratory depression as the diaphragm (the main muscle involved in breathing) is weak.

General

Local skin infections - skin infections may have two consequences. First wound healing may be delayed and second there is a chance of the infection spreading internally into the new joint.

Airway Assessment

throat

During the operation you will have a tube put into your throat to help you breath and to deliver the anaesthetic.

For most people this is not a problem but for those who are obese, have a short neck and a small mouth, who have difficulty opening their mouths, have any swelling at the back of their mouth, are limited in how far they can flex or extend their neck this may be an issue and the anaesthetist needs to be forewarned.

Preoperative Medical Tests

All being well you will have passed your preoperative physical exam with flying colours. However, in a minority of cases, a problem will be found that requires further investigation. Don't be alarmed (I know that's easy to say!) but your doctor needs to decide if this is really the best time for you to undergo major surgery.

If there is a problem, small or large, get that sorted first.

The Preoperative Medical Tests page is packed with information about the types of investigations and tests your doctor may refer you for.




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