Preoperative medical evaluation: part 1: general principles and cardiovascular considerations

Abstract

A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to use sedation or general anesthesia as an adjunct to dental treatment. This article is the first of a 2-part sequence and will address general principles and cardiovascular considerations. A second article will address pulmonary, metabolic, and miscellaneous disorders.

Figure 1

Algorithm for managing patients who claim allergy to local anesthetics. If allergist referral is elected, items included in the arrowed box are reasonable requests for testing. (Adapted from deShazo RD, Kemp SF. JAMA. 1997;278:1903.)

Figure 2

Mallampati airway classification. An increase in Mallampati class correlates with increased risk for difficulty in airway management. Class I: complete visualization of uvula, tonsillar pillars, and soft palate. Class II: only partial visualization of the uvula. Class III: only soft palate visible. Class IV: only hard palate visible. (Redrawn from Frerk CM: Anaesthesia. 1991;46:1005–1008.)