A thorough preoperative evaluation will provide both anesthesiologist and surgeon valuable information which may alter the course of patient care. Anesthetic preoperative evaluation is composed of four components: patient history, physical examination, laboratory studies, and anesthetic plan. A review of systems examination is usually a useful approach; this includes assessment of cardiac, pulmonary, renal, hepatic, neurological, gastrointestinal, endocrinological/metabolic, musculoskeletal, psychiatric, gynecological and obstetric organ systems. For ENT surgery, most of the time, anesthetic-related reasons for cancellation are due to recent upper respiratory infection or non-compliance with preoperative fasting guidelines. Evaluation of patient capacity sometimes enters into the process of informed consent or refusal in the elderly. Traditionally, anesthesiologists often consider perioperative cardiac and pulmonary events relatively controlled and easily reversible. While most of the ENT procedures are in the low surgical risk category, some of the large elective ENT operations are considered intermediate-risk surgery.

Preoperative evaluation of patients presenting for transsphenoidal resection of pituitary tumors is a very complex process, requiring careful assessment of the patient's symptoms and the proper preoperative laboratory tests. This chapter presents two case studies, which highlight the proper preoperative evaluation for different types of pituitary tumors. The first case study is about a 32-year-old male who was referred for evaluation of a possible neuroendocrine disorder. The second case study is about a 36-year-old female with the appearance of purple abdominal striae and multiple ecchymoses on her arms and legs. Cushing's syndrome (CS) is the clinical manifestation of cortisol excess, and Cushing's disease (CD) specifically describes cortisol excess caused by an adrenocorticotropic hormone (ACTH) -secreting pituitary adenoma. The treatment of CD involves surgical resection of the pituitary adenoma, because removal of the lesion and rapid normalization of the serum cortisol improves survival in these patients.

Deep brain stimulation surgery for Parkinson's disease requires a systematic approach to preoperative assessment. The success of deep brain stimulation (DBS) surgery depends on proper patient selection, proper placement of the DBS electrode in the intended nucleus and proper programming. In view of this, the preoperative evaluation of the DBS patient assumes added importance. This chapter presents a case study of a 65-year-old male who was to be evaluated for DBS surgery. An awake intubation was performed and intraoperative electrophysiologic monitoring was employed during the surgery. This case highlights the following important preoperative evaluation issues in DBS patients: general surgical patient evaluation, disease-specific evaluation, neuropsychological evaluation, evaluation of associated medical conditions and airway evaluation. The neuropsychological assessment should include assessment of cognition, neuropsychiatric symptoms, social support, and goals for surgery. Understanding the medical and neuropsychological considerations of Parkinson's disease is essential for proper perioperative care.

Supratentorial craniotomy is a common case in neurosurgery during which both the neurosurgeon and anesthesiologist are modulating the same organ. This chapter presents a case study of a 61-year-old female who presented with new-onset seizures, which were preceded by several weeks of bilateral frontal headaches described as dull and achy. The patient was scheduled for tumor excision via stealth-guided craniotomy. The patient's anxiety, increased blood pressure, and bronchospasm were addressed immediately. The patient emerged within several minutes of the head dressing being applied, without bucking or coughing. Normally, a patient presenting for supratentorial craniotomy is best served by an organized and systematic approach. The chapter presents one strategy for the preoperative evaluation of these neurosurgical patients. Supratentorial craniotomy is a common case in neurosurgery during which both the neurosurgeon and anesthesiologist are modulating the same organ. Thoughtful planning and clear communication between the teams is required for optimal patient care.

The preoperative evaluation provides the opportunity for assessment of patient, surgical, and anesthetic risks in order to formulate an appropriate anesthetic plan. This chapter presents a case study of a 27-year-old female, who presented with new onset of bilateral upper extremity weakness and sensory changes in neck and upper back pain. Co-morbidities associated with spinal disease range from acute traumatic spinal column instability or spinal shock to decreased cardiopulmonary function from chronic thoracic cage deformity. A comprehensive history and physical examination is a crucial component of preparation for complex spine surgery. The airway examination may be notable for limited cervical spine range of motion as well as instability increasing the risk of spinal cord injury. In an effort to achieve a successful outcome, preoperative evaluation should be thorough and consists of careful assessment of the risks associated with patient pathophysiology, anesthetic requirements, and the surgery itself.

Subarachnoid hemorrhage (SAH) is a complex disease with high morbidity and mortality. Management of patients with SAH requires a multisystem approach. This chapter presents a case study of a 45-year-old female who had presented to an outside hospital with a 1-month history of progressive right-sided facial and body numbness that had worsened acutely over the week prior to her admission. The patient underwent definitive correction of the aneurysm the following day. Aneurysmal SAH is a neurologic emergency, resulting from blood extravasation into the subarachnoid space normally filled with cerebrospinal fluid (CSF), that requires complex treatment and monitoring. Patients present for elective clipping of an unruptured aneurysm or emergent surgery following SAH. Thorough assessment of the patient, effective organ support and correction of pathophysiology are vital prior to leaving the intensive care unit (ICU) for what may be a challenging case in the operating room.

The success rate of tubal anastomosis, measured as the rate of intrauterine gestations after surgery, is generally quite high, especially if there is an appropriate patient selection and evaluation prior to surgery. Laparoscopic technique of tubal anastomosis was developed in 1998 after many years of performing minilaparotomy and traditional microsurgery in several hundred cases. A specially designed, malleable, tubal cannulator is introduced through the cervix and guided to the proximity of the tubal ostia under laparoscopic control. The stent facilitates the performance of the laparoscopic tubal anastomosis tremendously. The laparoscopic approach is essentially identical to that of the open-abdomen technique except for the use of specialized instrumentation to facilitate its performance via laparoscopy. A proper preoperative evaluation of the ovarian reserve and male factor are important determinants as to whether the patient will be best served by having a laparoscopic tubal anastomosis or in vitro fertilization.