Pre-Anaesthetic Check-up (PAC)
Objectives of PAC
The Pre-Anaesthetic Check-up (PAC) is a systematic evaluation performed before anaesthesia to assess the patient’s current health status, identify potential preoperative risks, optimise the patient, and formulate an individualised anaesthetic plan.
The main objectives are:
- Assess the patient’s current health status
- Identify existing medical conditions and their severity.
- Assess functional capacity and physiological reserve.
- Identify anaesthesia-related risks
- Difficult airway
- Aspiration risk
- Cardiovascular instability
- Respiratory complications
- Drug allergy or previous adverse anaesthetic events
- Identify and assess comorbidities
- Cardiovascular disease
- Respiratory disease
- Diabetes mellitus
- Renal and hepatic disease
- Neurological disorders
- Haematological disorders
- Other relevant systemic diseases
- Review previous anaesthetic and surgical history
- Previous difficult intubation or ventilation
- Previous awareness
- Postoperative nausea and vomiting
- Drug reactions/anaphylaxis
- Malignant hyperthermia
- Prolonged neuromuscular blockade
- Optimise the patient’s medical condition
- Correct significant physiological or biochemical abnormalities where possible.
- Optimise poorly controlled comorbidities.
- Review and appropriately manage preoperative medications.
- Determine the need for investigations
- Investigations should be individualised according to the patient, comorbidities, and proposed surgery rather than performed routinely in every patient.
- Assess surgical and preoperative risk
- Consider patient-related factors.
- Consider the type and magnitude of surgery.
- Consider expected blood loss and physiological stress.
- Formulate an individualized anaesthetic plan
- Choice of anaesthetic technique
- Airway management plan
- Monitoring requirements
- Vascular access
- Analgesic strategy
- Postoperative disposition
- Counsel the patient and obtain informed consent
- Explain the proposed anaesthetic technique.
- Discuss relevant risks and alternatives.
- Address patient concerns and expectations.
- Plan postoperative care
- PACU vs HDU/ICU requirement
- Postoperative analgesia
- Respiratory support
- Anticipated postoperative complications
The PAC in one line
PAC = Assess → Identify risk → Investigate when indicated → Optimize → Plan → Counsel → Proceed
References
- Gropper MA, ed. Miller’s Anesthesia. 10th ed. Elsevier; 2025.
- Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology.
- American Society of Anesthesiologists. Practice Advisory for Preanesthesia Evaluation.