Preoperative examination and evaluation may not be possible

Even if the pre-operative examination is not possible one should try to get as much information from the surgeon or the patient as one is preparing for anaesthetizing the patient. Simple questions to the surgeon like:
What is the nature of the surgery? (This lets the anaesthetist know about the surgeons plans or length of time likely to be taken.
Anything positive (physiologically abnormal) found in the investigations.
Any illness for which treatment is continuing like diabetes, hypertension, hypothyroidism, the dose patient is taking, how long, nature of drug like tablet or soluble.
Dentures if any if not inspect the oral cavity, colour of tongue any shaky tooth. After reassuring of safe anaesthetic technique one can mention how he will be kept comfortable either by injection, local or general and what will he his state at the end of surgery.
Any instruction during surgery (if no sedation of G.A.) or in the postoperative period.
All this information can be had by the time you are preparing and waiting for the surgeon’s arrival in the operating room.
If one disagrees with the investigation reports or any new finding must be narrated to the surgeon in his room rather than in the presence of the patient.
A patient expressed surprise as to how he was not asked to keep blood-grouped and cross-matched when previously it was needed. The surgeon did not know about this history and laughed it off. Luckily on the operating table there was not much bleeding. The patient’s relatives gave history of recurrent nasopharyngeal fibroma, while the surgeon had diagnosed as a simple polyp.
Another patient refused anaesthesia as blood was not kept ready. Luckily the surgeon on the previous operation was accompanying and he had given history to the operating surgeon. The surgeon had to reassure him that if there is bleeding we have the equipment to stop it. The patient had dilatation of urethra for stricture and he bled every time after dilatation and he needed transfusion. The attending surgeon explained that he had no cystoscope and that is why he had brought the patient.
A doctor patient gave history of a cardiac arrest during a previous operation and hence wanted to know the details of the procedure of anaesthesia. On further questioning it was found that the incidence occurred in a dental chair under ethyl chloride anaesthesia and patient was reassured that we are not using the same drug.
Patient gave distinct history of G6PD deficiency, prolong scoline apnoea, sensitivity to local anaesthetic agents. Some volunteer the information and from some one has to extract information.
It is better to go through the X-rays and reports and if any doubt the query should be raised before anaesthesia or surgery. A male patient of 13-14 years was scheduled for removal of nasal polyp. Doubt was raised whether the senior surgeon has seen the patient. Even after expressing that a nasopharyngeal fibroma has not been excluded the junior still insisted that it is a usual polyp only. On removal of a part of the polyp, when patient started bleeding the surgeon was prevented from proceeding further and packing the nose only was done. The senior surgeon was called who on post rhinoscopic examination certified and confirmed the diagnosis of nasopharyngeal fibroma.
A patient was scheduled for plating femur. Casually asked for X- rays. Only AP view was shown. The surgeon was asked whether other view was taken. The surgeon who was over confident that it was not necessary. On opening, the # line which was single without displacement showed multiple # of the shaft running parallel which could have been detected if any other view was taken.