• Morbid obesity (greater than 40 BMI)
• Obstructive sleep apnea with continuous positive airway pres-
sure (CPAP)
• Previous adverse events with anesthesia, including malignant
hyperthermia and pseudocholinesterase deficiency
• Current medications that may adversely affect anesthetic choices
or outcomes
• Smoking or a history of alcohol or drug abuse (We shouldn't hesi-
tate to ask patients if they use street drugs, and if so, what and how
often.)
• Psychological status (Some patients need general anesthesia,
because they get extremely claustrophobic if their faces are covered.)
• Support system (If needed, is someone available to care for them
at home?)
• Coagulation (Is there a risk of DVT or pulmonary embolism?)
Carefully review lab tests, with particular focus on known underly-
ing conditions. Women of childbearing age should have HCG levels
tested, but most lab studies are not necessary, and the practice of get-
ting an EKG on everyone, regardless of condition, has fallen by the
wayside.
ASC concerns
Other risks related to anesthesia at an ASC include:
• Signs and symptoms of coronary artery disease (CAD), including
significant dysrhythmias, significant valvular disease or a pacemaker
(with or without AICD)
• History of stroke, especially one with residual effects
• Reactive airway disease, including COPD and/or asthma, especial-
ly when asthma patients are symptomatic and dependent on inhalers.
Asymptomatic asthmatic patients are low risk for complications, but
Anesthesia Alert
AA
2 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 7
