ABSTRACT
Preoperative assessment is an imperfect science; screening is now generally undertaken in nurse-led clinics though more and more trusts now have consultant-led clinics for the higher risk patients to attend. Valve disease is not uncommon in those aged 65 years and over. It is still likely that in most units that if a new murmur is detected at pre-assessment, the surgery will be deferred until this has been investigated. Pre-existing significant hypertension leads to cardiovascular instability during anaesthesia and increases morbidity and mortality. Respiratory disease is best managed by assessment of the patient's functional status. Sleep apnoea is not uncommon in the surgical population and does not in itself preclude surgery. Obesity is increasingly common in the surgical population. Malignant hyperthermia is a rare inherited condition which presents significant challenges at the time of surgery. Suxamethonium apnoea is an inherited deficiency in plasma cholinesterase which leads to prolonged duration of action of some muscle relaxants.
