A useful mnemonic for pre-anesthetic assessment
(A2 B2 C2 D2 E2 F2 G2)
Assessing patients preoperatively is an important starting point to formulate effective anesthetic plan. Pre‑anesthesia assessment includes a good history, a physical examination, and any indicated laboratory tests.
The guide lines of the American Society of Anesthesiologists (ASA) indicate that a preanesthesia visit should definitely include the following:
• An interview with the patient or guardian to review medical, anesthesia, and medication history
• An appropriate physical examination
• Review of diagnostic data (laboratory, electrocardiogram, radiographs, consultations)
• Assessment of ASA physical status score (ASA‑PS)
One of the solutions to effective pre‑anesthetic checkup is the use of good mnemonic that covers all aspects of pre‑anesthetic assessment completely. The mnemonic is A2, B2, C2, D2, E2 F2, and G2.
(A2 B2 C2 D2 E2 F2 G2)
A ‑ Affirmative history:
The history of present surgical condition with the details of progression to present state. Details of past illness and treatment should be elicited.
A ‑ Airway:
Perform detailed airway examination and have a plan for airway management.
B ‑ Blood hemoglobin, blood loss estimation, and blood availability:
Check for hemoglobin level and take measures to improve. Assess the requirement of blood based on expected blood loss and preoperative hemoglobin. Ensure availability of blood.
B ‑ Breathing:
Look for respiratory rate, pattern, and dyspnea.
C ‑ Clinical examination:
Assess pulse volume, rhythm, and blood pressure. Do detailed systemic examination.
C ‑ Co‑morbidities:
Look for co‑morbid diseases like diabetes, hypertension, asthma, and epilepsy and optimize the end organ problems.
D ‑ Drugs being used by the patient:
Elicit the details of current drug therapy and allergies to plan anesthesia.
D ‑ Details of previous anesthesia and surgeries:
Elicit the details of previous anesthesia and surgeries to anticipate anesthetic difficulty.
E ‑ Evaluate investigations:
Look for appropriate investigations that would guide anesthetic management.
E ‑ End point to take up the case for surgery:
to avoid unnecessary postponement if further optimization is not possible.
F ‑ Fluid status:
Follow fasting guidelines appropriate to the age and surgery.
F ‑ Fasting:
Advice adequate duration of fasting for that particular age to prevent aspiration.
G ‑ Give physical status:
Assess ASA physical status classification.
G ‑ Get consent:
Discuss the surgical problems and the anesthetic risk with the patient or guardian to obtain appropriate consent.
A - Affirmative history; Airway
B - Blood hemoglobin, blood loss estimation, and blood availability; Breathing
C - Clinical examination; Co-morbidities
D - Drugs being used by the patient; Details of previous anesthesia and surgeries
E - Evaluate investigations; End point to take up the case for surgery
F - Fluid status; Fasting
G - Give physical status; Get consent