The preoperative assessment (POA) of a patient presenting for surgery is a crucial component of management and embraces medical, surgical and anaesthetic care. The preoperative assessment should contribute to the patient's management and in particular to the decision-making process. For high-risk patients a multidisciplinary decision regarding the risk–benefit of the proposed surgery should be encouraged. An accurate preoperative assessment should allow the team to:

• determine the need for surgery based on the patient's general status (should we operate; what should be performed; when should it be done?)

• identify and optimize co-existing disease

• select the best anaesthetic technique and perioperative management.

Assessment should be directed towards the individual patient and may be divided into: history, physical examination and investigations.

History

The best source of information relevant to any subsequent anaesthesia is obtained from a thorough history. A questionnaire can be given to the patient prior to clerking as a starting point, followed by more direct interrogation on receiving positive responses.

History of previous anaesthesia

The presence of co-existing disease and certain conditions are particularly relevant to anaesthesia. Warning notices following adverse reactions or complications during anaesthesia may be visible on patient records. Previous anaesthetic records should be examined for more detailed explanations.