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This book aims to serve as a comprehensive guide for healthcare professionals involved in the care of patients undergoing surgery. It provides a thorough exploration of the preoperative assessment and management strategies that are essential for optimizing patient safety, enhancing surgical outcomes, and improving overall patient satisfaction. The preoperative period is a dynamic and multifaceted phase where numerous factors converge, including medical history, physical examination findings, laboratory investigations, and specialized assessments. This book delves into the systematic evaluation of patients, highlighting key considerations such as risk stratification, patient optimization, and the identification and management of comorbidities. It emphasizes the importance of interdisciplinary collaboration, involving surgeons, anesthesiologists, nurses, and other healthcare professionals, to ensure a holistic and individualized approach to patient care. Throughout the book, we explore various surgical specialties and procedures, recognizing the unique challenges and considerations associated with each. From cardiac and geriatric surgeries to trauma and neurosurgical interventions, we address the specific requirements and nuances that contribute to a successful preoperative plan. It is our hope that this book will serve as a valuable resource for healthcare professionals at all levels, including surgeons, anesthesiologists, primary care physicians, nurses, and students. By providing evidence-based information, practical insights, and best practices, we aim to empower healthcare providers in their mission to deliver exceptional preoperative care. We extend our heartfelt gratitude to the numerous experts and practitioners who have contributed their knowledge and expertise to this project. Their collective wisdom and dedication have enriched the content and ensured its relevance to contemporary surgical practices. Finally, we would like to express our sincere appreciation to the readers. Your pursuit of knowledge and commitment to improving patient care inspires us. We hope that this book will serve as a valuable companion on your journey to mastering the art and science of preoperative assessment and management.

Recent studies have supported the use of quadratus lumborum block (QLB) for postoperative analgesia for patients undergoing renal surgery.The aim was to study the efficacy of posterior QLB for postoperative analgesia in patients undergoing percutaneous nephrolithotomy (PCNL).This trial was a hospital-based, randomized, double-blind, controlled, prospective study.Forty patients aged from 18 to 60 years, belonging to the American Society of Anesthesiologists physical status I-III and scheduled for unilateral PCNL under spinal anesthesia were administered ultrasound-guided posterior QLB with 30 ml of either 0.2% ropivacaine (Group Q) or normal saline (Group C) after the subarachnoid block. Duration of analgesia was the primary outcome variable.Data were compiled in Microsoft Excel, and analyses were performed in SPSS (version 24.0.0.0; IBM, Armonk, New York, USA). UnpairedDuration of analgesia was significantly longer in Group Q (1167.10 ± 89.74 vs. 290.25 ± 47.38 min), as compared to Group C. Except at the end of the surgery, visual analog scale at rest and on movement was significantly lower till 20QLB provides good quality, and prolonged duration of postoperative analgesia compared to placebo for PCNL, but more large-scale studies are needed to recommend it for routine use.

Context: I-gel is a second-generation supraglottic airway device. Despite several studies on i-gel, there are very few studies on the use of i-gel in obese patients. Aims: The aim of the study was to compare the clinical performance of i-gel between obese and nonobese patients. Settings and Design: Prospective, controlled, nonrandomized, hospital-based study. Subjects and Methods: After obtaining informed consent, patients were divided into two groups of 16 patients each: group O consisted of patients with body mass index (BMI) >30 kg/m2 and Group C consisted of patients with BMI 18.5–29.9 kg/m2. I-gel was inserted after induction of anesthesia and muscle relaxation. Oropharyngeal leak pressure (OLP) (primary outcome variable), leak fraction, time taken to insert the device, ease of insertion, fiberoptic view of glottis through i-gel's airway tube, and adverse effects were recorded. Statistical Analysis Used: Data were analyzed using SPSS 20. Continuous, ordinal, and categorical variables were analyzed using students t-test, Mann–Whitney U–test, and Fischer's exact test, respectively. Results: OLP was slightly higher in Group O (25.38 ± 4.79 cm H2O) but was not statistically different than Group C (27.38 ± 4.38 cm H2O). Other parameters except weight and BMI (which were higher in Group O) were statistically similar in both groups. There was no statistical difference in side effects. Conclusions: We concluded that i-gel is as effective in obese patients as in nonobese patients when used for securing the airway for surgical procedures.

Dexmedetomidine is used as spinal anesthetic adjuvant for potentiating the actions of local anaesthetics. We devised this study to compare the effects of 3, 5 and 10 μg dexmedetomidine on 3 ml of 0.75% isobaric ropivacaine in patients undergoing inguinal hernia repair. 64 patients were divided into 4 groups. Group 1 was given spinal ropivacaine, while groups 2, 3 and 4 received additional 3, 5, 10 μg dexmedetomidine respectively. Duration of two segment sensory regression (72.25±9.46, 97.63±8.17, 125.63±9.96, 125.63±9.96 minutes in groups 1, 2, 3 and 4 respectively), duration of analgesia (156.00±8.40, 278.38±13.69, 356.00±11.84, 441.56±16.62 minutes in groups 1, 2, 3 and 4 respectively), motor block (133.31±10.90, 258.25±23.29, 330.50±22.66, 408.63±19.14 minutes in groups 1, 2, 3 and 4 respectively) and sensory block (188.00±13.26, 188.00±13.26, 384.50±30.85, 487.50±40.60 minutes in groups 1, 2, 3 and 4 respectively) were significantly prolonged in patients receiving dexmedetomidine in a dose dependent manner. Peak sensory block and side effects were unaffected by dexmedetomidine. We conclude that dexmedetomidine prolongs the duration of sensorimotor block and analgesia in a dose dependent manner.

Elderly patients often have multiple comorbid conditions. We describe here anesthetic management of an elderly patient having rheumatic heart disease with severe aortic stenosis, severe mitral stenosis, severe pulmonary hypertension and chronic kidney disease planned for hemireplacement arthroplasty. We used continuous spinal anesthesia, an underutilized technique, which provided stable hemodynamic conditions without any complications in perioperative period.